体外静脉-静脉转流在62例原位肝移植手术中的应用

Application of Extracorporeal Veno-venous Bypass in Orthotopic Liver Transplantation

目的 :研究体外静脉转流在原位肝移植手术的应用 ,以便正确预防和处理体外静脉转流引起的病理生理变化。方法 :62例原位肝移植患者在无肝期均采用体外静脉转流 ;转流中加强监测血流动力学、凝血功能、血气及血生化 ;转流中均使用离心泵。结果 :(1)无肝期应用体外静脉转流对无肝期的血流动力学及新肝期的循环再灌注起到有效调控作用。(2)手术各期无明显酸碱紊乱 ,仅转流后有轻微酸中毒。(3)凝血功能有不同程度紊乱。(4)离心泵和肝素涂抹管路的应用 ,使血液有形成分破坏少 ,围术期出血量明显减少。结论 :无肝期采用体外静脉转流 ,有助于稳定循环 ,无明显酸中毒及高血钾 。

Objective:To investigate the application of veno_venous bypass(VVB)in orthotopic liver transplantation for prevention of various pathophysiological changes.Methods:VVB was used in 62 patients during the anhepatic phase.Hemodynamics,coagulation,blood gas,blood,and biochemistry were monitored during VVB.Centrifugal pump was used in all patients.Results:(1)Hemodynamics remained stable in all patients during anhepatic phase and neohpatic phase.(2)No patients showed obvious acid_base disturbance intraoperatively.(3)Disturbance of coagulation function to a certain degreee occurred.(4)With the use of centrifugal pump and heparin_bonded tubing,effective composition of blood was less broken.Blood loss was obvious reduced during different phases of hepatic transplantation.Conclusion:The use of VVB during anhepatic phase can be helpful to keep hemodynamics stable and prevent obvious acidosis and hyperkalemia.Coagulation and blood gas monitoring should be paid attention during VVB and after VVB.