肝移植麻醉中肺动脉高压的预防及探讨

The prevention and discussion of pulmonary arterial hypertention in anesthesia of liver transplantation

目的探讨原位肝移植麻醉中再灌注时肺动脉高压的预防。方法30例肝移植的患者年龄25～45岁。随机分为两组,I组对照组,麻醉诱导后根据患者CVP值调整输液量,将CVP值调整到10～12cmH2O,II组实验组,麻醉诱导后在循环稳定的前提下控制输液速度,将CVP控制在4～5cmH2O。记录监测术前(即无肝前期)、再灌注后即新肝期10分钟、新肝期20分钟、30分钟、40分钟以及关腹前的CVP、PAP、PAWP、CCO的变化,同时抽静脉血查血清精氨酸酶,动脉血做血气分析记录pH、K+将两组新肝期各时段与术前各指标的变化值做统计学比较。结果PAP、PAWP、pH、K+两组之间有显著的差异,I组升高值高于II组且有统计学意义(P<0.001),CCO、血清精氨酸酶两组之间有差异,但无统计学意义。结论肝移植前期合理的控制液体量,将CVP降低到一定的安全值可以有效的预防再灌注时肺动脉压的升高,对维持循环稳定以及降低围术期死亡率有一定的积极作用。

Objective Discussion of prevention of pulmonary arterial hypertention in the time of re-perfusion of anes- thesia of liver transplantation. Methods 30 patients of liver transplantation, 25 - 45 years old. Randomly divided into two groups, one group is control group,after anesthetic induction, based on CVP value of patient, to adjust infusion volume, to make sure the CVP number is in 10 - 12 cmH20. The second group is testing group, after anesthetic induction, under balance circulation, control infusion speed, control the CVP value on the range of 4 - 5 cmH2O. Monitor and record before operation, after reperfusion, that is 10min, 20min, 30min, 40min of new liver, and the changing of CVP, PAP, PAWP before closing of abdomen, on the meantime, check serum arginase by venous blood, statistical comparison of changing value of two groups. Results PAP, PAWP, arginase having obvious statistical value （P 〈 0.001 ）. Conclusion In the early stage of liver transplantation, control the infusion volume in reasonable low level. Reduce CVP to certain safe value, can effectively prevent pulmonary arterial hypertention in reperfusion, having certain proactive effect in maintain balance circulation.