晚期肝泡型包虫病患者行自体肝移植的拔管时间及术中血气分析的研究

Research on extubation time and arterial blood gas analysis of ex vivo liver resection followed by autotransplantation in patients with advanced hepatic alveolar echinococcosis

目的探讨行离体肝切除联合自体肝移植术的晚期肝泡型包虫病(hepatic alveolar echinococcosis,HAE)患者术后气管导管拔管时间与术中基本因素的相关性,分析术中血气结果变化趋势。方法收集2014年2月—2017年8月四川大学华西医院24例行离体肝切除联合自体肝移植手术的晚期HAE患者资料,对其进行回顾分析。结果患者拔管时间与术中麻醉时长(r=0.472,P=0.031)、出血量(r=0.524,P=0.015)、红细胞悬液输入量(r=0.627,P=0.002)、血浆输入量(r=0.617,P=0.003)存在相关性。术后3个月内有、无肺部并发症发生的患者拔管时间比较,差异无统计学意义[(23.74±15.84)、(15.52±19.40)h,P=0.327]。患者动脉血血气p H值、血糖、乳酸、碱剩余等指标在各时点与阻断前比较差异均有统计学意义(P<0.05)。血钾在术毕较阻断前升高(P<0.05),游离钙在阻断后和开放后与阻断前比较出现一过性下降(P<0.05),血红蛋白在阻断后和开放后下降较明显(P<0.05)。结论离体肝切除联合自体肝移植术中尽量减少麻醉时长和出血,可以缩短带管时间改善预后。其无肝期较长,使得患者术中血气分析变化大,术中应加强血气分析监测,及时调整,维持酸碱及电解质的稳定。

Objective To explore the correlations between the time of tracheal extubation and the intraoperative basic factors of ex vivo liver resection followed by autotransplantation in patients with advanced hepatic alveolar echinococcosis （HAE）, and analyze the change trend of blood gas analysis during operation. Methods The data of 24 patients with advanced HAE who underwent ex vivo liver resection followed by autotransplantation in West China Hospital of Sichuan University between February 2014 and August 2017 were retrospectively analyzed. Results There were significant correlations between the extubation time and the duration of anesthesia （r=0.472, P=0.031）, the amount of bleeding （r=0.524, P=0.015）, the amount of erythrocyte suspensions infusion （r=0.627, P=0.002）, and the amount of plasma infusion （r=0.617, P=0.003）. There was no statistical difference in extubation time between patients with and without pulmonary complications in 3 months postoperatively [（23.74±15.84）, （15.52±19.40） h, P=0.327]. Compared with those arterial blood gas results before the interruption, the pH value, blood glucose, lactic acid and base excess were statistically significantly different （P〈0.05） at each time point after the interruption. Blood potassium increased at the end of operation compared with that before interruption （P〈0.05）; and the free calcium after blocking and opening increased with a temporary decrease （P〈0.05）; the hemoglobin decreased significantly after interruption and clamping （P〈0.05）. Conclusions Anesthesia length and bleeding should be reduced in ex vivo liver resection followed by autotransplantation, thus the extubation time would be shortened and the prognosis of the patients might be improved. Because of the longer anhepatic phase, the blood gas analysis varies largely. During operation, blood gas analysis and monitoring should be strengthened, and the acid-base balance and electrolytes should be maintained in time.