肝移植手术的麻醉管理

Anesthesia management for liver transplantation

肝移植患者术前具有复杂的血流动力学改变、内环境紊乱及凝血功能异常,手术期间受体原有的病理生理改变进一步加剧,加之缺血再灌注损伤均给麻醉带来很大的困难,麻醉中应加强多系统功能监测,给予正确的容量治疗及维持受体血流动力学稳定、电解质平衡及一定的凝血功能。肝移植术前应详细了解病情,术中尽量维持各项指标的平稳,减轻缺血再灌注带来的损伤,麻醉中正确处理肝功能衰竭和手术引起的循环不稳定状态、代谢紊乱及凝血障碍是肝移植手术成败的关键。

Before liver transplantation, the patients represent the changes of hemodynamics, disorder of internal environment and disfunction of blood clotting. Built-in pathophysiological changes may be aggravated and liver ischemic reperfusion injury severes the anesthesia during operation. It is very important to enhance multisystem monitor, have correct transfusion treatment and maintain stabilization of hemodynamics, acid-base balance, as well as blood clotting function during anesthesia management. Before liver transplantation, anesthetists should understand patients＇ condition in details. It is critical for a successful operation to maintain the index balance, relieve the ischemic reperfusion injury, manage the liver function failure during anesthesia, as well as adjust the changes of hemodynamics, metabolic disorder and blood clotting disfunction.