肝移植术后再次手术的麻醉处理

Anesthetic Treatment of Patients after Orthotropic Liver Transplantation

目的总结27例肝移植术(OLT)后患者行非肝脏手术的临床麻醉经验,探讨其特点。方法2003年2月—2007年6月共有27例OLT术后患者施行了非肝脏手术,其中,术后早期开腹探查8例,腰椎肿瘤14例,神经纤维瘤3例,上臂肿瘤1例,肾上腺肿瘤1例,5例合并高血压。男性22例,女性5例。26例患者采用了静吸复合全身麻醉;1例患者采用臂丛神经阻滞。结果术后早期开腹探查术平均手术时间为(102±33)min,19例非肝脏手术时间为(156±21)min;早期开腹探查术术后拔管时间平均为(30±21)min,非肝脏手术术后拔管时间平均为(18±11)min;早期开腹探查术术中出血平均为(282±198)ml,非肝脏手术术中出血平均为(837±221)ml,术中8例患者输血。全部患者均未使用去氧肾上腺素和肾上腺素。所有患者无围术期死亡;术后无肺部感染和其他部位感染;术后无一例发生肝、肾功能衰竭;术后未发生一例急性排异反应。结论OLT术后患者再手术的麻醉选择应考虑多方因素,围术期应保持血流动力学平稳,保护肝脏功能,防治感染等。

Objective To summarize our experience in anesthetic management after orthotropic liver transplantation （OLT）. Methods From February 2003 to June 2007,27 patients with OLT undergoing elective and acute surgical operation received anesthesia. Five of 19 patients were complicated with hypertension. General anesthesia （ intravenous and inhalational anesthesia） was administered in 26 patients, and the other one received brachial plexus block. Results The mean operative time was 156 ± 21 min, the mean postoperative intubation time was 18 ± 11 min, the mean blood loss was 837 ±221 ml, and eight patients received blood infusion： All patients were not given adrenaline and phenylephrine in operation and survived without organic infections, hepa- torenal dysfunction, and acute rejection reaction. Conclusion Special consideration should be given to the choice of anesthesia for the patients after OLT. It is important for anesthetists to maintain hemodynamic stability and to protect vital organs＇ ction.