原位肝移植术围术期机体组织氧供氧耗的变化

Variations of oxygen delivery and oxygen consumption of tissues during perioperative orthotopic liver transplantation

目的 探讨体外静脉 静脉转流下原位肝移植术病人组织氧供氧耗的变化 ,了解肝移植病人围术期组织的氧代谢情况。方法 静吸复合全身麻醉下终末期肝病病人 15例 ,在无肝期采用体外静脉 静脉转流 ,转流量为 95 0～ 180 0ml·h-1。用HP多功能监测仪无创监测ECG、SpO2 、PETCO2 、Temp。经右颈静脉穿刺放入Swan Ganz漂浮导管 ,经左侧的桡动脉置入动脉套管 ,两者通过换能器连接HP多功能监测仪 ,有创持续监测动脉压 (ABP)、右房压 (RAP)、肺动脉压 (PAP)、肺动脉嵌压(PAWP)、血温 (TB)。分别在术前、无肝前、无肝期转流 30min、新肝前期、新肝期 30min、术毕采桡动脉血和肺动脉血作血气分析 ,用温度热稀释法测CO。记录组织的氧合指标 ,包括动脉血氧分压 (PaO2 )、动脉血氧饱合度 (SaO2 )、混合静脉血氧分压 (PvO2 )、混合静脉血氧饱合度 (SvO2 )、氧供 (DO2 )、氧耗(VO2 )、氧摄取率 (ERO2 ) ,氧供指数 (DO2 I)。结果 PaO2 、SaO2 、PvO2 、SvO2 、CaO2 、CvO2 、AaDO2 各期无显著性差异 ;O2 ER、VO2 、DO2 和DO2 I在新肝期早期增大 ;VO2 在新肝各期均增大。结论 原位肝移植进入新肝期氧耗量增大 ,代谢增加 。

Objective To observe the changes of oxygen delivery and oxygen consumption of tissues during orthotopic liver transplantation (OLT)Methods Fifteen patients with end disease of hepatism were scheduled for OLT under combined general anesthesia Veno-venous bypass was applied to all the cases during the anhepatic phase ECG, SpO_2 and P_ ETCO_2 were monitored during whole procedures 7-French pulmonary artery catheter was inserted into right jugular vein and an arterial line was put in the left radial artery, to measure hemodynamics and tissue oxygenation parameters including arterial partial pressure of oxygen(PaO_2), arterial oxygen saturation(SaO_2),arterial oxygen content(CaO_2),alveolar-arterial oxygen difference(AaDO_2) mixed venous oxygen pressure (PvO_2),mixed venous oxygen saturation (SvO_2), mixed venous oxygen content(CvO_2), oxygen delivery (DO_2),oxygen delivery index (DO_2I), oxygen consumpation (VO_2), oxygen consumpation index (VO_2I) and oxygen extraction rate (ERO_2) during perioperationResults There were no significant changes in PaO_2, PvO_2, SvO_2, CaO_2, CvO_2 and AaDO_2 during perioperation (P>005) As compared with those before operation ERO_2, VO_2I, DO_2 and DO_2I increased significantly during early neohepatic stages (P<005), and VO_2 rose obviously markedly following the neohepatic procedure(P<005) Conclusions The oxygen delivery and oxygen consumption during OLT are associated with the variations possibly due to metabolism of new liver