背驮式肝移植术门脉高压症患者血液动力学分析

Hemodynamic Changes in Patients with Portal Hypertension during Piggyback Orthotopic Liver Transplantation

目的观察分析背驮式肝移植术门脉高压症患者血液动力学改变.方法 20例门脉高压症终末期患者在静-吸复合全身麻醉下行背驮式肝移植术.并记录手术开始后30 min、无肝期5 min、无肝期30 min及新肝期3 min、新肝期10 min、新肝期30 min的中心静脉压(CVP)、肺动脉平均压(MPAP)、肺动脉楔压(PAWP)、心脏指数(CI)、体循环阻力指数(SVRI)、肺循环阻力指数(PVRI)血液动力学指标.结果无肝期MPAP、PCWP、CVP均低于手术开始后30 min(P<0.05),但SVI、CI减少不明显,无肝期血液动力学基本平稳;在新肝开放后血液动力学指标的变化明显,MPAP、PCWP、CVP升高(P<0.01),CI降低,肺动脉平均压(MPAP)和肺循环阻力指数(PVRI)增高(P<0.05).结论背驮式肝移植术门脉高压症患者血液动力学指标的变化明显,应加强此术式血液动力学的监测和管理,特别是在新肝开放后,血液动力学指标的变化更明显.

Objective To investigate the hemodynamic changes in patients with portal hypertension during piggyback orthotopic liver transplantation.Method Twenty patients with portal hypertension of ASAⅡ～Ⅳ,aged 28～63,were performed OLT by general anesthesia without veno-venous bypass.Hemodynamics changes such as CVP,MPAP,PAWP,CO,CI,SVR,SVRI,PVR,PVRI were recorded at 30 min after operation was stared,at 5 min anhepatic phase and 30 min anhepatic phase and at 3 min neohepatic phase and 10 min neohepatic phase and 30 min neohepatic phase.Results MPAP,PCWP and CVP were significantly decreased during anhepatic phase（P0.05）.MPAP,PCWP and CVP were increased during neohepatic phase（P0.01）and PVRI and MPAP were increased during neohepatic phase while CI was decreased（P0.05）.Conclusion The changes of hemodynamics are still significant during piggyback orthotopic liver transplantation without veno-venous bypass,and closely monitoring and management are needed,especially during neohepatic phase.