肝脏移植手术期间机体组织氧代谢和乳酸的变化

CHANGES IN OXYGEN METABOLISM AND LACTATE OF TISSUES DURING THE OPERATION OF LIVER TRANSPLANTATION

目的 研究肝脏移植手术期间机体组织氧代谢和乳酸水平的变化。方法 观察 17例终末期肝病或肝癌患者在背驮式肝移植术围麻醉期血气、心指数 (CI)、混合静脉血氧饱和度 (SvO2 )、氧供 (DO2 )、氧耗 (VO2 )、氧摄取率 (O2 ER)和动脉血乳酸含量 (ABL)的动态变化。结果 与术前相比 ,CI、SvO2 、DO2 、VO2 、O2 ER在无肝前期无明显变化 ;无肝期 5minCI、DO2 、VO2 降低 (P <0 0 5 ) ;无肝期 30minSvO2 升高 ,VO2 、O2 ER显著降低 (P <0 0 5 ) ;新肝期 5minSvO2 、DO2 、VO2 增加 ,O2 ER仍较低 (P <0 0 5 ) ;新肝期 30min后DO2 、VO2 、O2 ER均显著增加 (P <0 0 5 ) ;各期乳酸含量均明显上升 (P <0 0 5 )。结论 肝脏移植围术期存在明显氧代谢障碍 ,以无肝期和新肝早期最严重 ;

Objective To study the changes in oxygen metabolism and lactate content of tissues during liver transplantation. Methods Blood gas, cardiac index(CI),mixed venous oxygen saturation(SvO 2 ),oxygen delivery(DO 2 ),oxygen consumption(VO 2 ),oxygen extraction rate(O 2 ER) and arterial blood lactate(ABL) were assayed in 17 patients undergoing liver transplantation. Results The results showed that no significant changes in CI, SvO 2 , DO 2 , VO 2 , O 2 ER as compared with those before operation( P >0 05). CI, SvO 2 , DO 2 were decreased significantly in the early 5min of the anhepatic stage( P <0 05), while SvO 2 was increased and VO 2 , O 2 ER decreased significantly during 30min of this stage ( P <0 05). SvO 2 , DO 2 , VO 2 were increased and O 2 ER decreased significantly in the early 5min of the neohepatic stage( P <0 05), while DO 2 , VO 2 , O 2 ER were increased significantly in the 30min of this stage ( P <0 05). Lactate content rose obviously during the whole surgical procedure( P <0 05). Conclusion The results suggested that imbalance of oxygen metabolism was evidently present during the operation of piggyback orthotopic liver transplantation, and it was especially remarkable in anhepatic and early neohepatic stages. Therefore, comprehensive measures should be adopted early in the anesthesia to promote the oxygen extraction and utilization of the tissues