To assess the feasibility and outcome of orthotopic liver transplantation(OLT) with no veno-venous bypass(v-v hypass)in adult patients.Methods:Between 1999 and 2001 ,43 adult patients underwent OLT with v-v bypass,33 ...To assess the feasibility and outcome of orthotopic liver transplantation(OLT) with no veno-venous bypass(v-v hypass)in adult patients.Methods:Between 1999 and 2001 ,43 adult patients underwent OLT with v-v bypass,33 with no v-v bypass.The operation time,anhepatic time,amount of blood loss,amount of blood transfusion,ICU stay days of the two groups were compared.renal function and gastrointestinal function in the two groups were examined.Results:There was no significant difference in mean serum creatinine on day 3 and gas discharge time in patients with v-v bypass or not.With no v-v hypass,the average operation time was 5.7±1.3 hours,anhepatic time was 64±13 minutes,median amount of blood loss in operation was 4000±820mL,median amount of blood transfused intracperatively was 4650±910mL,median ICU stay was 5.7 days;all those were lower or shorter than those with v-v hypass.and these differences betweent the two groups had statistical significances.Conclusion:OLT with no v-v bypass is safe and can be performed in the majority of adult patients.The practice of liver transplantation with no v-v hypass is associated with shorter total operation time.shorter anhepatic time,lower blood product ussege,and shorter ICU stay compared with standard technique of OLT with routine use of v-v bypass.展开更多
BACKGROUND: The clearance of propofol is very rapid, and its transformation takes place mainly in the liver. Some reports indicated extrahepatic clearance of the drug and that the lungs are the likely place where the ...BACKGROUND: The clearance of propofol is very rapid, and its transformation takes place mainly in the liver. Some reports indicated extrahepatic clearance of the drug and that the lungs are the likely place where the process occurs. This study was undertaken to compare the plasma concentrations of propofol both in the pulmonary and radial arteries after constant infusion during the dissection, anhepatic and reperfusion phases of orthotopic liver transplantation (OLT) without veno-venous bypass, attempting to investigate extrahepatic clearance and to determine whether the human lungs take part in the elimination of propofol. METHODS: Fifteen patients undergoing OLT without veno-venous bypass were enrolled in the study, and propofol was infused via a forearm vein at a rate of 2 mg· kg-1·h-1. Blood samples were simultaneously collected from pulmonary and radial arteries at the end of the first hepatic portal dissection (T0), at the clamping of the portal vein (T1), 30, and 60 minutes after the beginning of the anhepatic phase (T2, T3), and 30, 60, and 120 minutes after the unclamping of the new liver (T4, T5, T6). Plasma propofol concentrations were measured using a reversed- phase, high-performance liquid chromatographic method with fluorescence detection. RESULTS: The concentrations of plasma propofol in the pulmonary and radial arteries at T2 and T3 rose significantly compared with T0 and T1 (P<0.01) respectively. After reperfusion, the drug concentrations at T4, T5 and T6 decreased significantly compared with T2, T3 (P<0.01)respectively. There were no significant differences in plasma propofol concentrations between the pulmonary and radial arteries at any time points. CONCLUSIONS: Propofol is eliminated mainly by the liver, and also by extrahepatic organs. The lungs seem to be not a major site contributing to the extrahepatic metabolism of propofol in humans.展开更多
文摘To assess the feasibility and outcome of orthotopic liver transplantation(OLT) with no veno-venous bypass(v-v hypass)in adult patients.Methods:Between 1999 and 2001 ,43 adult patients underwent OLT with v-v bypass,33 with no v-v bypass.The operation time,anhepatic time,amount of blood loss,amount of blood transfusion,ICU stay days of the two groups were compared.renal function and gastrointestinal function in the two groups were examined.Results:There was no significant difference in mean serum creatinine on day 3 and gas discharge time in patients with v-v bypass or not.With no v-v hypass,the average operation time was 5.7±1.3 hours,anhepatic time was 64±13 minutes,median amount of blood loss in operation was 4000±820mL,median amount of blood transfused intracperatively was 4650±910mL,median ICU stay was 5.7 days;all those were lower or shorter than those with v-v hypass.and these differences betweent the two groups had statistical significances.Conclusion:OLT with no v-v bypass is safe and can be performed in the majority of adult patients.The practice of liver transplantation with no v-v hypass is associated with shorter total operation time.shorter anhepatic time,lower blood product ussege,and shorter ICU stay compared with standard technique of OLT with routine use of v-v bypass.
文摘BACKGROUND: The clearance of propofol is very rapid, and its transformation takes place mainly in the liver. Some reports indicated extrahepatic clearance of the drug and that the lungs are the likely place where the process occurs. This study was undertaken to compare the plasma concentrations of propofol both in the pulmonary and radial arteries after constant infusion during the dissection, anhepatic and reperfusion phases of orthotopic liver transplantation (OLT) without veno-venous bypass, attempting to investigate extrahepatic clearance and to determine whether the human lungs take part in the elimination of propofol. METHODS: Fifteen patients undergoing OLT without veno-venous bypass were enrolled in the study, and propofol was infused via a forearm vein at a rate of 2 mg· kg-1·h-1. Blood samples were simultaneously collected from pulmonary and radial arteries at the end of the first hepatic portal dissection (T0), at the clamping of the portal vein (T1), 30, and 60 minutes after the beginning of the anhepatic phase (T2, T3), and 30, 60, and 120 minutes after the unclamping of the new liver (T4, T5, T6). Plasma propofol concentrations were measured using a reversed- phase, high-performance liquid chromatographic method with fluorescence detection. RESULTS: The concentrations of plasma propofol in the pulmonary and radial arteries at T2 and T3 rose significantly compared with T0 and T1 (P<0.01) respectively. After reperfusion, the drug concentrations at T4, T5 and T6 decreased significantly compared with T2, T3 (P<0.01)respectively. There were no significant differences in plasma propofol concentrations between the pulmonary and radial arteries at any time points. CONCLUSIONS: Propofol is eliminated mainly by the liver, and also by extrahepatic organs. The lungs seem to be not a major site contributing to the extrahepatic metabolism of propofol in humans.
