成人活体部分肝移植与全肝移植麻醉管理的比较

Comparison of anesthetic management for adults undergoing living donor liver transplantation and cadaveric liver transplantation

目的:探讨成人活体部分肝移植与全肝移植麻醉的特点。方法:回顾分析我院2006年5月—2007年4月进行的34例肝移植麻醉,其中成人活体部分肝移植11例,全肝移植23例。采用静吸复合全身麻醉,术中监测血流动力学、血气、生化指标、凝血功能、体温及出血量等。结果:活体部分肝移植患者术前MELD评分明显高于全肝移植患者;与全肝移植相比,活体部分肝移植无肝期和新肝期略延长,出血量增多,死亡率略高,但差异无统计学意义(P>0.05)。结论:相对于全肝移植,活体部分肝移植的麻醉管理难度更高。

Objective： To investigate the Anesthetic management during the procedure of adult living donor liver transplantation and cadaveric liver transplantation. Methods： Thirty-four patients underwent liver transplantation under general anesthesia from May 2006 to April 2007 in Chinese PLA general hospital. Anesthetic managements for eleven patients who underwent living donor liver transplantation and twenty-three patients who underwent cadaveric liver transplantation were analyzed retrospectively. During the operation, hemodynamics and temperature were continuously monitored. Blood gas, biochemistry and coagulation were detected regularly. Blood loss was calculated. Results： The MELD value of patients who accept living donor liver transplantation was significantly higher than that of patients who accept cadaveric liver transplantation. Perioperational mortality, amount of bleeding, time of anheptic phase and neoheptic phase have no difference between the patients who accept living donor liver transplantation and the patients who accept cadaveric liver transplantation. Conclusions： Anesthetic management in living donor liver transplantation is more difficult than that in cadaveric liver transplantation.