非转流腔静脉成形肝移植术中容量管理的探讨

The management of blood volume with no-bypass in liver transplantation for primary liver cancer

目的:探讨原发性肝癌肝移植非静脉转流术中容量管理的特点与方法。方法:52例原发性肝癌行腔静脉成形术非转流肝移植术患者,采用静吸复合全身麻醉。术中监测血流动力学、血气、生化指标、凝血功能、体温、尿量及出血量等。根据腔静脉成形术非转流肝移植术中各期的特点和术中具体情况连续推注小剂量多巴胺等活性药物,并在低中心静脉压(CVP)根据血流动力学与血气分析指标决定输液种类和数量。结果:围术期血流动力学基本平稳。pH值和BE等代谢指标变化较大。血浆乳酸浓度切肝期降低,在无肝期、新肝期升高。无肝期尿量维持有效量,血浆肌酐(Cr)在新肝期增高。结论:静脉成形术非转流肝移植的术中容量管理相当重要与复杂,选用连续输注小剂量多巴胺,并以低CVP控制静脉压的容量管理,根据监测指标决定输液种类和数量,能维持有效容量,达到循环稳定,改善肾功能。

Objective ：To investigate anesthetic management of blood volume during suprahepatic venacavaplasty in liver transplantation for primary liver cancer. Methods：General anesthesia with tracheal intubed was conducted in 52 patients liver cancer undergoing liver transplantation. Hemodynamics, blood gas, biochemistry, coagulation function, temperature, urinary output and bleeding output were monitered. According to the different characteristics of the each phase of operation and results of the hemodynamics and blood gas, kind and amount of fluid were administered in the low central venous pressure with small dose of dopamine administered. Results ：The hemodynamics was kept stale, pH value and BE had obvious changes. Lactic acid decreased during liver incision and increased during anhepatic and neohepatic phase. Urinary output during anhepatic period was maintained, serum creatinine（Cr） concentration was increased during neohepatic phase. Conclusion： There are profound changes during suprahepatic venacavaplasty in liver transplantation. The management of blood volume in the low central venous pressure with small dose of dopamine contiunously administered may maintain effective blood volume and stable circulation and improve renal function.