改良背驮式原位肝移植手术各期的液体管理

Liquid Control in Patients Undergoing Piggyback Orthotropic Liver Transplantation

目的探讨改良背驮式原位肝移植围术期血容量的变化及液体管理。方法对56例改良背驮式原位肝移植患者实施术中液体管理,术中持续监测心电图(ECG)、有创血压(ABP)、心率(HR)、中心静脉压(CVP)及肺动脉压(PAP),部分病例监测连续心排量(CCO)。记录肝移植各期的出入量。结果56例患者均顺利渡过手术期,术中总出血量平均为(3895.8±2443.9)ml(无肝前期及新肝期出血量相当,无肝期较少),总出液量(6784.3±3928.8)ml(以新肝期为主),总输血量(4563.8±1361.7)ml,总入液量(8721.8±3396.4)ml。无肝期HR增快、BP及CVP下降显著(均P<0.05)。结论改良背驮式原位肝移植患者手术期间出入量变化极大,术中密切监测患者各项循环指标,加强液体管理,维持血容量和血流动力学的稳定,保护患者重要器官是手术成功的关键。

Objective To observe the changes of blood volume in patients undergoing piggyback orthotropic liver transplantation （OLT） and find a better way of liquid control. Methods Fifty-six patients undergoing OLT were implemented liquid control. ECG, ABP, HR and CVP, PAP, HR were continuously monitored during operation. Continuous cardiac output （CCO） was additionally observed in some patients. All the intake and output volume of liquid were respectively recorded in various stages. Results All the patients went through the operation period uneventfully. The total blood loss was （3 895.8±2 443.9） ml （the blood loss in pre-anhepatic period was close to that in neo hepatic period. The blood loss during anhepatic period was least）. The total liquid output was （6 784.3 ± 3 928.8） ml on average （mainly from neohepatic time）. The total amount of blood transfused was （4 563.8 ± 1 361.7） ml and the total input of liquid was （8 721.8±3 396.4） ml. HR was increased during anhepatic period and BP and CVP were all decreased （P〈0.05 for all）. Conclusion The volume of liquid output and input varies greatly during OLT. Closely monitoring all circulation indicators, strict liquid control, maintaining the blood volume and hemodynamic stability, protecting impor tant organs are keys to the success of the operation.