原位肝移植术中血液生化指标的动态监测及其临床意义

Monitoring and Significance of Blood Biochemistry During Orthotopic Liver Transplantation

目的 探讨血液生化指标的动态变化在原位肝移植术中的临床意义。方法 于术中不同时点抽取动脉血作血气分析、电解质和血糖测定。结果 无肝前期 ,血糖水平高于正常并有逐渐升高的趋势 ,其他监测指标均在正常范围内 ;无肝期 ,动脉血 pH逐渐降低 ,碱剩余 [BE]负值加大 ,血液电解质无明显变化 ,血糖较无肝前期进一步升高 ;再灌注期 ,随着移植肝循环开放 ,酸中毒进一步加重 ,血钾升高 ,血糖有所降低 ,但仍高于正常。结论 在原位肝移植术中 ,受体出现代谢性酸中毒且逐渐加重 ;移植肝循环开放后血钾升高 ;无肝前期血糖明显升高 ,无肝期血糖升至峰值 ,随后逐渐下降。血液生化指标动态监测有助于术中根据生化指标变化及时采取相应的治疗措施。

Objective To investigate the significance of the changes of blood biochemistry during orthotopic liver transplantation.Methods The arterial blood was sampled for monitoring arterial blood gas tensions,Na +,K +,Cl - and blood glucose levels.Results During preanhepatic stage,blood glucose levels increased progressively,blood electrolytes and acid-base balance were stable.During anhepatic stage,pH was decreased,base deficit was increased significantly,blood electrolytes were stable,and blood glucose levels were increased higher than that in preanhepatic stage.During neohepatic stage,acidosis became more severe,blood potassium increased abruptly on reperfusion of the grafted liver,and blood glucose was decreased but higher than the normal level.Conclusion During operation of liver transplantation,metabolic acidosis of recipients developed progressively,blood potassium increased significantly on reperfusion of the grafted liver,blood glucose increased during the preanhepatic stage and increased to the top during the anhepatic stage and then decreased progressively.Monitoring the blood biochemistry was helpful for correct managements during the operations.