终末期肝病原位肝移植术围手术期的血流动力学和内稳态变化及麻醉处理

The study of perioperative hemodynamic and homeostasis changes and anesthesia management in patients with end-stage liver OLT

目的探讨终末期肝病患者在原位肝移植(OLT)手术治疗过程中的血流动力学和内稳态变化情况以及麻醉处理办法。方法选择7例终末期肝病且接收OLT手术治疗的患者为观察对象,于T_0(麻醉前)、T_1(诱导期)、T_2(无肝前期)、T_3(无肝期0.5 h)、T_4(新肝期)、T_5(新肝期0.5 h)、T_6(术后)等几个时间点监测患者的血流动力学指标[平均动脉压(MAP)、中心静脉压(CVP)、平均肺动脉压(MPAP)、肺小动脉楔压(PAWP)]变化情况和电解质及酸碱平衡指标的(Na^+、pH、K^+、BE、Ca^(2+))变化情况。结果血流动力学指标MAP、CVP、MPAP、CO、PAWP围手术期不同时间点比较,其中T_2~T_5变化最明显,差异均具有非常明显的统计学意义(P<0.01);电解质及酸碱平衡指标的pH、BE、Ca^(2+)围手术期不同时间点比较,差异均有非常明显的统计学意义(P<0.01);Na^+围手术期不同时间点数值比较差异无明显的统计学意义(P>0.05);K^+围手术期不同时间点数值比较差异有明显的统计学意义(P<0.05)。结论终末期肝病患者在OLT手术治疗过程中,血流动力学和内稳态变化变化大,特别是无肝期和新肝期变化尤为明显,加强监测、及时处理可以纠正。

Objective To explore the perioperative hemodynamic and homeostasis changes and anesthesia management in patients with end-stage liver OLT.Methods 7 cases of patients with end-stage liver disease who received OLT were selected as observation objects.Hemodynamic index（ MAP,CVP,MPAP,CO,PAWP） and the changes of electrolyte and acid-base balance index of（ Na＋,pH,K＋,BE,C2＋）were monitored in T0（ before anesthesia）,T1（ induction period）,T2（ not the early stage of the liver） and T3（ without liver period 0.5 h）,T4（ liver）,T5 new liver（ 0.5 h） and T6（ after the operation）.Results Hemodynamic parameters：MAP,CVP,MPAP,CO,PAWP perioperative compare different time points,F value were 18.09,29.74,16.43,7.46,16.00,had very significant statistical significance（ P〈 0.01）.For the electrolyte and acid-base balance of the p H value of the indicators,BE different time points,Ca2 ＋perioperative comparison,F value were13.68,27.08,8.12,all difference had obvious statistical significance（ P〈 0.01）.The Na＋perioperative numerical comparison in different time points has no obvious statistical difference（ P〉 0.05）;the difference of K＋perioperative numerical in different time points was significant（ P〈 0.05）.Conclusion In the process of OLT surgery in patients with end-stage liver disease,hemodynamic and homeostasis change a lot,and especially in no liver period and new stage change.It can be corrected by the strengthening of monitoring and managed timely.