肝移植患者术中各期动脉血二氧化碳分压与呼气末二氧化碳分压变化的比较

Comparison of partial pressure of end-tidal CO_2 and partial CO_2 pressure between different stages in patients receiving non-bypass orthotopic liver transplantation

目的探讨非转流经典原位肝移植术中患者动脉血二氧化碳分压(PaCO2)与呼气末二氧化碳分压(PetCO2)的差值[P(a-et)CO2]的变化。方法104例行非转流经典原位肝移植的患者,采用气管内插管静吸复合麻醉。除监测血流动力学外,同时于麻醉后,无肝前期,无肝期30、60 min,移植肝下腔静脉开放后5、30 min,以及手术结束时监测动脉血气指标,同时记录PetCO2,计算P(a-et)CO2。结果与麻醉后相比,无肝前期、无肝期30和60 min、下腔静脉开放后5和30 min及手术结束时的心率显著增快(P值均<0.01),pH值显著降低(P值均<0.01);无肝前期的平均动脉压(MAP)显著升高(P<0.01),无肝期30 min和下腔静脉开放后5 min的MAP显著降低(P值均<0.01);无肝期30和60 min、下腔静脉开放后5和30 min及手术结束时的PaCO2显著升高(P值分别<0.05、0.01),下腔静脉开放5、30 min及手术结束时的PetCO2显著升高(P值分别<0.05、0.01),无肝期30、60 min及下腔静脉开放后5 min的P(a-et)CO2显著增高(P值均<0.05)。结论非转流原位肝移植无肝前期P(a-et)CO2维持稳定,无肝期P(a-et)CO2显著增大,移植肝下腔静脉开放后30 min后逐渐恢复至术前水平。

Objective To investigate the changes of the difference between partial pressure of end-tidal 002 （PetCO2） and partial 002 pressure [-P （a-et）CO2 in patients receiving non-bypass orthotopic liver transplantation. Methods Totally 104 patients received non-bypass orthotopic liver transplantation for end-stage liver disease under general anesthesia. The hemodynamics was monitored continuously. Arterial blood gas （ABG） and PetCO2 were recorded after induction of anesthesia, before cross-clamping of the portal vein, 30 min and 60 min in anhepatic phase, 5 rain and 30 rain after unclamping the inferior vena cava and at the end of surgery. The P（a-et） CO2 was calculated. Results Compared to that after anesthesia induction, the heart rates were significantly increased before cross-clamping of the portal vein, at 30 min, 60 min of anhepatic phas, 5 min, 30 min after unclamping the inferior vena cava, and at the end of operation （all P〈0.01）; the pH values were significantly decreased （all P〈0.01）; the mean artery pressure （MAP） value was significantly increased before cross-clamping of the portal vein （P〈0.01）; the MAP values were significantly decreased at 30min of anhepatic phase and 5 min after unclamping the inferior vena cava （both P〈 0.01 ）; the partial 002 pressures were significantly increased at 30 min, 60 rain of the anhepatic phase, 5 min, 30 rain after unclamping the inferior vena cava, and at the end of operation （ P〈0.05 or 0.01） ; the PetCO2 was significantly increased 5 min, 30 min after unclamping the inferior vena cava, and at the end of operation （ P〈 0.05 or 0.01 ） ~ and P （a-et） CO2 was significantly increased at 30 min, 60 min of the anhepatic phase 30 min, and at 5 min after unclamping the inferior vena cava （all P〈0.05）. Conclusion In orthotopic liver transplantation patients, the P（a-et）CO2 remains stable before cross-clamping of the portal vein. During anhepatic phase it is significantly increased and recovered to the level of baseline level 30 min after unclamping the inferior vena cava. （Shanghai Med J, 2009, 32： 963-965）