43例原位肝移植病人手术中血电解质浓度的变化

Changes of plasma electrolytes concentrations during liver transplantation: a clinical study of forty-three patients undergoing orthotopic liver transplantation

目的:动态观察原位肝移植手术期间病人血电解质浓度的变化。方法:患者在气管插管全身麻醉下行肝移植手术。分别于麻醉诱导前及手术开始后各期定时抽取桡动脉血标本做血浆钠、钾、氯、钙水平测定。结果:血钾在无肝期及肝脏再灌注5～15分钟后明显降低,而在再灌注后1～5分钟内明显升高(最高7.2mmol·L^(-1))。所有病人血钙浓度从手术开始后即呈下降趋势,以无肝期尤为显著。术中血钠浓度轻度升高,但极少超出正常值范围。血氯浓度在手术各期无明显变化。结论:在无肝期及再灌注5～15分钟后,应注意纠正低血钾。但在肝脏再灌注后短时间内,要警惕严重高血钾的发生。由于低血钙普遍存在于所有病人,应及时给予补充,以预防低血钙造成的心肌抑制。

Objective: To investigate changes of plasma electrolytes concentration during orthotopic liver transplantation. Method:Forty-three patients suffering from end-stage liver diseases underwent orthotopic liver transplantation. Blood samples were taken from radial artery before anesthesia induction and periodically throughout the operation to measure plasma electrolytes levels with American Corning automatic blood-gas and electrolytes analyzer. Result: During anhepatic phase and 5-15 min after revascularisation,mean plasma potassium concentrations decreased significantly compared with that before induction. However,immediately following revascularization of the newly transplanted liver(within 5 min). mean potassium concentration increased significantly(maximally 7.2 mmol/L). Plasma calcium concentration decreased soon after the start of the operation. Supplementation of chloride calcium was required more or less in all patients. Compared with that before induction,slight increases in mean plasma sodium concentrations were observed during the operations, but within normal range. Plasma chloride concentrations did not differ significantly between the phases. Conclusion:During anhepatic phase and 5-15 min after revascularization,a supplementation of KCl is necessary to restore the potassium level to normal. However,immediately following revascularization,be aware of the profound increases in plasma potassium concentrations caused by a washout of the solution used to cool the liver. An injection of chloride calcium is recommended with plasma calcium is below 1.0 mmol/L.