非转流原位肝移植术患者术中血浆胶体渗透压的变化

Changes in plasma colloid osmotic pressure during off-pump orthotopic liver transplantation

目的分析非转流原位肝移植术患者术中血浆胶体渗透压的变化。方法择期经典非转流原位肝移植术患者30例，年龄35—60岁，ASAⅡ～Ⅳ级，肝功能Child—Pugh分级B或C级。静脉注射咪达唑仑、舒芬太尼、异丙酚及维库溴铵行麻醉诱导，静脉输注异丙酚，吸入异氟醚，并间断静脉注射舒芬太尼及维库溴铵维持麻醉。术中静脉输注入血白蛋白注射液及新鲜冰冻血浆等液体，无肝前期维持血红蛋白浓度70～80g／L，尿量1ml·kg^-1·h^-1，中心静脉压4～7mmHg；无肝期维持血红蛋白浓度80—100g／L，尿量0．5ml·kg^-1·h^-1，中心静脉压0．3mmHg；新肝期维持尿量1～2ml·kg^-1·h^-1，中心静脉压4～10mmHg。于建立肘正中静脉通路时（L）、切皮即刻（T1）、无肝前期60min（T2）、无肝即刻（T3）、无肝期30min（T4）、新肝即刻（T5）、新肝期30min（T6）及术毕（T7）时取静脉血样5ml，测定血浆胶体渗透压、血浆晶体渗透压及血清白蛋白浓度。结果与T0时比较，T2-6时血浆胶体渗透压、T2-7时血清白蛋白浓度及T4-7时血浆晶体渗透压均升高（P〈0．05或0．01），但仍在正常范围内。结论非转流原位肝移植术中常规液体管理可维持正常血浆胶体渗透压，提示常规液体管理方案是可行的。

Objective To investigate the changes in plasma colloid osmotic pressure （COP） in patients undergoing off-pump orthotopic liver transplantation （ OLT）. Methods Thirty ASA Ⅱ - Ⅳ patients （liver function Child-Pugh grade B or C） aged 35-60 yr undergoing off-PUmp OLT were studied. Anesthesia was＂ induced with midazolam, sufentanil, propofol and vecuronium and maintained with propofol infusion, isoflurane inhalation and intermittent iv boluses of sufentanil and vecuronium. Human albumin and fresh frozen plasma were infused during operation. Hemoglobin was maintained at 70-80 and 80-100 g/L during preanhepatic and anhepatic Phase respectively. Urine output was maintained at 1, 0. 5 and 1-2 ml· kg^- 1·min^-1 while CVP at 4-7, 0-3 and 4- 10 mm Hg respectively during preanhepatic, anhepatic and neo-hepatic phase. Blood samples were taken immediately before intravenous line was established （To , baseline）, at skin incision （%）, 60 min of preanhepatic phase （T2 ） beginning of anhepatic phase （T3）, 30 min of anhepatic phase （T4）, beginning of neohepatic phase （T5 ）, 30 min of neohepatic phase（T6 ） and the end of operation （T7 ） from internal jugular vein for determination of plasma COP, crystalloid osmotic pressure and serum albumin concentration. Results The plasma COP at T2-6 , serum albumin concentration at T2-7 and plasma crystalloid osmotic pressure at T4-7 were significantly increased as compared with the baseline at To （ P 〈 0.05 or 0.01 ）. Conclusion Plasma COP can be maintained at normal level by routine fluid administration in patients undergoing off-pump OLT.