肝移植后早期血流动力学的监测

Early postoperative monitoring of hemodynamics in liver transplantation patients

背景:接受肝移植的患者均为晚期肝病患者,由于肝功能损害,心室负荷加重,导致心肌肥大,心肌间质纤维化,心脏收缩、舒张功能同样受到损伤。BioZ.Com无创血流动力学监测仪基于胸腔生物电阻抗,可无损伤地提供反映左心室泵血功能参数及收缩功能参数。目的:采用美国BioZ.Com无创血流动力学监测仪,检测终末期肝病患者肝移植后早期的血流动力学变化情况。设计、时间及地点:病例观察,于2005-01/2006-12在解放军总医院第二附属医院干部病房完成。对象:选择接受原位肝移植的患者50例。方法:应用美国BioZ.Com无创血流动力学监测仪监测肝移植患者移植后7d内血流动力学参数的变化,包括心率、平均动脉压、心输出量、心脏指数、每搏输出量、外周血管阻力、心脏收缩加速指数及胸腔液体量水平等。主要观察指标:肝移植后早期(ICU内)不同时段患者的血流动力学指标。结果:肝移植后第2天开始患者心输出量、心脏指数、每搏输出量、心脏收缩加速指数明显低于移植前(P<0.01),外周血管阻力、胸腔液体量水平明显高于移植前(P<0.01),这种变化于移植后第3天达到高峰,移植后第7天各项血流动力学指标逐渐恢复至移植前水平。结论:肝移植后患者血流动力学不稳定,尤以移植后二三天最重。因此,密切监测其血流动力学变化,及时调整治疗方案,是肝移植患者平稳度过围手术期的关键。

BACKGROUND： Liver transplantation is always performed in patients with hepatopathy at advanced stage, who have damaged liver function and ventricle load, leading to myocardial hypertrophy, myocardial interstitial fibrosis, heart contraction, and damaged diastolic function. Bioz.Com Cardiodynamics Monitor reflects left ventricle blood-pumping function parameters and systolic function parameters based on thoracic cavity bio-electrical impedance. OBJECTIVE： To investigate hemodynamics changes after liver transplantation using American Bioz.Com Cardiodynamics Monitor. DESIGN, TIME AND SETTING： Case observation. The experiment was performed at the Cadre Ward, Second Affiliated Hospital of General Hospital of PLA between January 2005 and December 2006. PARTICIPANTS： A total of 50 patients underwent orthotopic liver transplantation. METHODS： Seven days after surgery, the American Bioz.Com Cardiodynamics Monitor was used to evaluate heart rate, systolic blood pressure, diastolic blood pressure （DBP）, mean arterial pressure （MAP）, cardiac output/index （CO/CI）, stroke volume/index （SV/SI）, velocity index （VI）, acceleration index （ACI）, pre-ejection period （PEP）, systolic time ratio （STR）, thoracic fluid content （TFC）, and systemic vascular resistance/index （SVR/SVRI）. MAIN OUTCOME MEASURES： Hemodynamical parameters of patients early after liver transplantation. RESULTS： After 2 days, CO, CI, SV, and ACI decreased significantly （P 〈 0.01）, while SVR and TFC increased （P 〈 0.01） compared with before surgery. The changes in hemodynamics reached peak after 3 days and resumed after 7 days. CONCLUSION： Hemodynamics was not sustained after liver transplantation, especially after 2-3 days. Monitoring of hemodynamics manage is important to patient survival after liver transplantation.