非转流经典原位肝移植术中的容量管理

目的探讨非转流经典原位肝移植术中的循环变化和容量管理。方法选取本院肝胆外科择期行非转流经典原位肝移植术患者64例,术中记录各时段出血量、尿量及补液种类、补液量,监测血流动力学、血气、生化指标、凝血机能、血糖和体温变化等。结果血流动力学在无肝期和新肝早期变化显著(P<0.01),pH值和碱剩余(BE)值也有显著变化(P<0.05或P<0.01),电解质和凝血功能由于术中不断及时调整纠正变化不大。结论非转流经典原位肝移植术时机体循环变化和内环境紊乱较为显著,术中容量管理十分重要。应选择合适液体合理补液以及使用血管活性药物和相关药物,维持血流动力学和内环境的相对稳定,尽可能避免发生与容量相关的并发症。

The Volume Management during Typical Orthotropic Liver Transplantation without Bypass

Objective To investigate the circulation changes and volume management during typical orthotropic liver transplantation without bypass.Methods 64 patients which would accept typical orthotropic liver transplantation without bypass in liver and gall department in our hospital were involved in this research.Bleeding volume,urinary volume,the category and volume of infused fluid were recorded.Haemodynamics,blood gas,biochemical indicator,coagulation function,blood glucose and temperature changes were monitored during the operation.Results Haemodynamics changed significantly during an hepatic phase and neohepatic phase (P< 0.01).PH and base excess(BE) also had distinct changes (P<0.05 or P< 0.01).Because continuously adjustment and correction during the course of operation,the electrolyte and coagulation function changed little.Conclusions The circulation changes and internal environment disorder are significant during typical orthotropic liver transplantation without bypass,so the volume management is very important.Proper fluid and reasonable fluid infusion,vasoactive agent and correlated medicine should be used to maintain haemodynamics and internal environment stable and try to avoid the complication related to blood volume.