肝肺联合移植术一例的麻醉处理

Analysis of anesthesia for combined liver-lung transplantation in one case

目的:分析肝肺联合移植手术的麻醉处理。方法:采用全静脉麻醉诱导和维持,在体外膜肺氧合辅助下施术。根据血流动力学监测和食管超声检查指导输血、输液和血管活性药物的使用。对血流动力学、通气模式、容量管理、凝血功能等方面实施个体化的调控。结果:术中循环稳定、氧合良好,术后第3天撤除体外膜肺氧合,第4天撤除呼吸机。术后第10天出现顽固性低氧血症,经呼吸机辅助呼吸和肺动脉球囊扩张治疗效果不佳。术后第32天在等待再次移植中因感染性休克、心搏骤停死亡。结论:肝肺联合移植术的麻醉不仅要求血流动力学和内环境稳定,而且在容量管理、通气策略、凝血功能等方面应个体化管理。

Aim:To analyze the anesthesia of combined liver-lung transplantation in one patient.Methods:Total intravenous anesthesia was used for induction and maintenance.The operation was performed under the support of extracorporeal membrane oxygenation.According to hemodynamic monitoring and transesophageal echocardiography,blood transfusion,infusion and the use of vasoactive drugs were guided.Individualized regulation of hemodynamic,ventilation mode,volume management and coagulation were implemented.Results:During operation,the circulation was stable and the oxygenation was satisfying.Extracorporeal membrane oxygenation was weaned on the 3rd day after operation,and ventilator was removed on the 4th day after operation.Obstinate hypoxemia occurred on the 10th day after operation,and the effect of ventilator assisted respiration and pulmonary artery balloon dilatation was poor.On the 32nd day after operation,the patient died of septic shock and cardiac arrest while waiting for retransplantation.Conclusion:The anesthesia for combined liver-lung transplantation requires not only the stability of hemodynamics and internal environment,but also the individualized management of volume management,ventilation strategy and coagulation function.