原位肝移植术中机体组织氧代谢指标的变化

Changes of oxygen metabolism indexes in organism tissue during orthotopic liver transplantation

目的观察肝移植术中机体组织氧代谢指标的变化。方法观察50例终末期肝病患者肝移植术中血气、心指数(CI)、氧合指数和血糖的动态变化。结果与术前相比,无肝期前CI、SvO2、DO2、VO2、O2ER无明显变化;无肝期5minCI、DO2、VO2降低(P<0.05);无肝期30minSvO2升高,VO2、O2ER显著降低(P<0.05);新肝期5minSvO2、DO2、VO2增加,O2ER仍较低(P<0.05);新肝期30min后DO2、VO2、O2ER均显著升高(P<0.05)。结论肝移植手术无肝期和新肝早期氧代谢障碍最显著。机体组织氧代谢动态监测有助于术中根据其变化及时采取相应治疗措施。

Objective To investigate the changes of oxygen metabolism indexes in organism tissue during orthotopic liver transplantation. Method The blood gas, cardiac index （CI）, mixed venous oxygen saturation（SvO2）, oxygen delivery（DO2）, oxygen consumption（VO2）, oxygen extraction rate（O2ER） and arterial blood glucose（ABG） were measured in the 50 patients who underwent liver transplantation. Results Compared with preoperative values, no significant changes in CI, SvO2, DO2, VO2 and O2ER were showed in pre-anhepatic stage; CI, SvO2 and DO2 decreased significantly at the early 5 rain of the anhepatic stage（P〈0.05）, with VOz and OzER decreased significantly at the 30 min of the anhepatic stage （P〈0.05）; SvO2,DO2 and VO2 increased, and meanwhile O2ER decreased significantly at the early 5 min of the neohepatic stage （P〈0.05）; DO2,VO2 and O2ER increased significantly at the 30 min of the neohepatic stage （P〈0.05）. Conclusion During pre-anhepatic stage and early neohepatic stage of orthotopic liver transplantation there is most significant oxygen metabolism dysfunction. And the dynamic monitoring oxygen metabolism in tissue may help to adopt relative treatment timely according to its changes.