体外静脉-静脉转流下原位肝移植术病人体、肺循环的变化

Changes of systemic and pulmonary hemodynamics during veno-venous bypass in liver transplantation

目的 观察体外静脉 静脉转流下原位肝移植体肺循环血液动力学的变化。方法 2 0例原位肝移植手术病人 ,在无肝期采用体外静脉 静脉转流术 ,采用Swan Ganz漂浮导管监测不同时期体、肺循环血液动力学的变化。结果 与基础值相比 ,手术期间MAP基本稳定 ;中心静脉压(CVP)、心输出量 (CO)、心脏指数 (CI)、左心功指数 (LVSW )和右心功指数 (RVSW ) ,在转流期间有降低 ,在开放后新肝期 15分钟有增高 (P <0 0 5 ) ;肺动脉压 (PAP)和肺毛细血管楔压 (PAWP)在新肝期15分钟一定增加 (P <0 0 5 ) ;体循环阻力 (SVR)在无肝期增高 ,在新肝期 15分钟降低 (P <0 0 5 ) ;肺血管阻力 (PVR)在新肝期 15分钟增高 ;心率在转流期间加快 (P <0 0 5 )。结论 原位肝移植手术中 ,在无肝期采用体外静脉 静脉转流术有助于血压的稳定 ,但体、肺循环血流动力学在无肝期和新肝早期仍有明显的变化。

Objective To observe the changes of systemic and pulmonary hemodynamics during veno-venous bypass in liver transplantation Methods During the anhepatic phase, extracorporeal veno-venous bypass (EVVB) was utilized in 20 patients undergoing live transplantation Systemic and pulmonary hemodynamics were monitored through Swan-Ganz catheter during whole procedures Results As compared with the preoperative values , MAP remained unchanged in normal range during perioperative period;CO,CI,LVSW and RVSW decreased significantly during anhepatic phase and increased markedly 15 min after hepatic reperfusion (P<0 05) ; PAP and PAWP increased greatly 15 min after the reperfusion (P<0 05); SVR increased obviously during anhepatic phase and decreased significantly 15 min after the reperfusion (P<0 05) ; PVR increased 15 min after the reperfusion (P<0 05); HR increased during anhepatic phase(P<0 05) Conclusions EVVB is helpful for maintaining BP stable during liver transplantation, but systemic and pulmonary hemodynamics may still change greatly during anhepatic phase and initial stage of neohepatic phase