两种血流动力学管理策略术后早期对肝移植受者的影响

目的 探讨采用Swan-Ganz导管与中心静脉导管监测血流动力学参数指导治疗对肝移植患者术后早期的影响.方法 107例肝移植受者中102例入选,随机数字表法分为肺动脉导管(PAC)组(52例),中心静脉导管(CVC)组(50例).两组均监测中心静脉压、平均肺动脉压、心率、平均动脉压、肺动脉嵌顿压、心输出量和氧输送量等,按既定血流动力学管理方案用血管活性药物或持续静脉-静脉血液滤过治疗控制各项指标在目标范围内.结果 两组患者的基本资料的差异无统计学意义.PAC组住重症监护病房期间死亡率为7.7%,CVC组为4.0%.PAC组术后28 d死亡率为11.5%,CVC组为8.0%.PAC组ICU住院时间中位数为2.5 d,CVC组为2 d.PAC组机械通气时间中位数为26.5 h,CVC组为24 h.以上各项指标的差异均无统计学意义(P＞0.05).两组术前及术后第1、5天肾功能和肝功能以及术后第1、2、3天血乳酸的差异均无统计学意义(P＞0.05).PAC组发生-过性室性心律失常共26例;CVC组发生2例.结论 肝移植术后采用Swan-Ganz导管监测血流动力参数指导治疗并不优于采用中心静脉导管监测中心静脉压的方法,反而增加-过性室性心律失常的发生率.

Postoperative two hemodynamics management strategies on the early impact of liver transplantation recipients

Objective To investigate early postoperative impact on recipients after liver transplantation with the two hemodynamic management strategies by using the "gold standard" Swan-Ganz catheter and central venous catheter (CVC) to monitor hemodynamics and guide liquid and vasoactive drug therapy.Methods From May 2006 to January 2009,102 from 107 cases of liver transplantations in our hospital were randomly divided into two groups:PAC group (pulmonary artery Swan-Ganz catheter group,n = 52) and CVC group (n = 50 cases).Hemodynamic parameters were monitored.Results There was no significant difference in the general characteristics between two groups In PAC group and CVC group,the mortality during ICU stay was 7.7 % and 4 %; postoperative 28-day mortality was 11.5 % and 8 % ; the median mechanical ventilation time was 26.5 and 24 h; the median ICU stay was 2.5 and 2 days,respectively.There was no significant difference in the aforementioned parameters (P＞0.05).There was no significant difference in renal function and liver function before and 1,5 days after operation,and mean blood lactic acid level 1,2,and 3 days after operation between two groups (P＞0.05).In PAC group and CVC group,transient ventricular arrhythmias occurred in 26 cases and 2 cases Conclusion It is not a good strategy using "gold standard" Swan-ganz catheter to monitor hemynamic parameters and guide therapy after liver transplantation in ICU,and on the contrary,the application of "gold standard" Swan-ganz catheter increases incidence of transient ventricular arrhythmias.