儿童活体肝移植围手术期血流动力学和电解质的变化及防治措施探讨

Changes in haemodynamics and electrolytes during perioperative period of living donor liver transplantation in children and their preventive measures

目的观察儿童活体肝移植围手术期血流动力学和电解质的变化，以寻找其防治措施。方法采用自身前后对照研究，监测并分析20例活体肝移植患儿术前及术后1、3、5、7d的血流动力学和电解质变化。结果与术前相比，术后1、3、5、7d收缩压（SBP）、舒张压（DBP）及平均动脉压（MAP）均显著升高[SBP（mmHg，1mmHg=0．133kPa）：106．60±9．58、116．75±9．11、117．95±12．15、116．45±8．73比92．75±6．72，DBP（mmHg）：63．85±10．33、70．70±10．98、70．90±12．92、74．65±15．51比53．95±12．43，MAP（mmHg）：78．15±9．30、85．30±9．44、85．35±13．85、85．90±13．94比66．45±8．83，均P〈0．05]，心率（HR，次／min）在术后5d明显降低（102．80±26．08比117．25±19．25，P〈0．05）；术后1d血Na^±（mmol／L）显著升高（146．52±5．89比139．36±3．91，P〈0．01），血K^±、Ca^2±叶。显著降低[K^±（mmol／L）：3．36±0．44比4．12±0．68，Ca^2±（mmol／L）：1．15±0．15比1．23±0．06，P〈0．01和P〈0．05），而术后3、5、7d血Na^±、K^±、Ca^2±变化不明显；术后1、3、5、7d血Mg^2±（mmol／L）显著降低（O．69±0．11、0．64±0．10、0．58±0．10、0．72±0．17比0．84±0．10，P〈0．05或P〈0．01）。结论儿童活体肝移植围手术期血流动力学变化以血压升高为主，术后早期电解质不稳定；早期诊断和治疗高血压、调控好电解质对提高移植成功率非常重要。

Objective To explore the preventive measures of disturbances of haemodynamics and electrolytes by observing their changes during perioperative period of living donor liver transplantation in children. Methods Twenty children who had undergone living donor liver transplantation operation were enrolled in the study, their haemodynamics and electrolyte parameters before operation and on the 1, 3, 5 and 7 days after the operation were monitored and analyzed. Results Compared with levels before operation, systolic blood pressure （SBP）, diastolic blood pressure （DBP） and mean arterial pressure （MAP） significantly increased on the 1, 3, 5 and 7 days after the operation [SBP （mm Hg, 1 mm Hg= 0. 133 kPa）： 106.60±9.58, 116.75±9.11, 117.95±12.15, 116.45i8.73vs. 92.75±6.72, DBP （mmHg）： 63.85±10.33, 70.70±10.98, 70.90±12.92, 74.65±15.51 vs. 53.95±12.43, MAP （mm Hg）： 78.15±9.30, 85.30±9.44, 85.35±13.85, 85.90±13.94 vs. 66.45±8.83, all P〈0. 05], but the heart rate （HR, bpm） was significant lowered only on 5 days after the operation （102.80±26.08 vs. 117.25±19.25, P〈0.05）. Blood Na^± （mmol/L） level rose significantly on the 1 day after the operation （146.52±5.89 vs. 139.36±3.91, P〈0.01）. On the same day, blood K^± and Ca^2± were declined significantly [K^± （mmol/L） ： 3.36± 0. 44 vs. 4. 12±0.68, Ca^2± （mmol/L） ： 1.15±0. 15 vs. 1.23±0. 06, P〈0.01 and P〈0. 05], but there was no obvious change in them on 3, 5 and 7 days. Significant decrease in blood Mg2± （mmol/L） was found on the 1, 3, 5 and 7 days after the operation （0. 69±0. 11. 0. 64±0.10. 0. 58±0. 10. 0.72±0. 17 vs. 0. 84±0.10, P〈0. 05 or P〈0. 01）. Conclusion Hypertension is the main haemodynamics change during perioperative period of living donor liver transplantation in children, and the levels of electrolytes are not stable in early postoperative period of liver transplantation. Early diagnosis and treatment of hypertension is important for children to recover from operation, and it is also important to maintain normal levels of electrolytes to obtain a successful liver transplantation.