经典原位肝移植术血流动力学变化的临床意义

Clinical Significance of hemodynamics in classical orthotopic liver transplantation

目的 :回顾性探讨经典原位肝移植术中血流动力学变化及处理。方法 :经典原位肝移植病人100例 ,无肝期选用体外静脉 -静脉转流(VVB)50例 ,非转流(NON -VVB)50例。采用Swan -Ganz漂浮导管监测无肝前期、无肝期5min、15min新肝期5min、15min及术毕各时段血流动力学参数变化。结果 :①VVB组 ,转流初始5min及再灌注10min血流动力学变化明显 ,(P<0.05)。②NON -VVB组门静脉下腔静脉阻断和再灌注时血流动力学变化均明显 ,MAP下降30 %、PCWPMPAP下降20 %、CVP及CO下降40 %(P<0.05)。结论 :原位肝移植无肝期采用VVB有助于维持血流动力学平稳。NON -VVB原位肝移植无肝期 ,采取快速输血输液 ,适当调整血管活性药物应用 ,再灌注时提前纠正酸中毒 ,补充钙剂对抗高钾对心脏的抑制等措施 。

Objective:To investigate the hemodynamic changes and treatments during typical liver transplantation.Methods:During the anhepatic phases,extracorporeal Veno-venous byˉpass(VVB)was utilized in50patients of liver transplantation,NON-VVB was utilized in the other50patients.Hemodynamic was monitored through Swan-Ganz catheter during preanˉhepatic,anhepatic and neohepatic stages.Results:(1)Start at5minutes of bypass and10minˉutes of again perfusion hemodynamic changes were most significant in VVB patients.(2)hemodynamic changes were most significant in50patients that did not undergo EVVB.MAP reduced30%and PCWP or MPAP20%and CVP or CO40%.Conclusion:VVB during the anhepatic phases is helpful to maintain hemodynamics stable.