非静脉转流经典原位猪肝移植麻醉

目的 探讨非静脉转流经典原位猪肝移植术的麻醉期管理.方法 将38头猪随机分为两组,分别为供体组和受体组,对实验猪行经口气管内插管+静脉复合麻醉,施行同种异体原位肝移植术.观察其各时相血流动力学、血气、血生化及肝功能的改变.结果 38头猪中35头成功施行气管插管,3头行气管切开.实验猪对麻醉药有较大的耐受量,无肝期麻醉药用量明显减少;无肝期和新肝期血流动力学变化剧烈并伴有代谢性酸中毒,血清K+在新肝期有一过性升高.在肝移植麻醉及手术过程中,平均动脉压(mean arterial pressure,MAP)、中心静脉压(central venous pressure,CVP)、心率(heart rate,HR)、碱剩余(bases excess,BE)、动脉血二氧化碳分压(PaCO:)等均有较大的波动,其中,在无肝期至新肝期后0.5 h变化最剧烈.结论 对实验猪实施经口气管内插管可行;无肝期不需要深麻醉状态;血流动力学改变的处理应以预防为主,随时纠正酸碱平衡紊乱.合理应对无肝期至新肝期后0.5 h期间的循环系统和机体内环境的剧烈变化是麻醉是否成功的关键.

Anesthesia for orthotopic liver transplantation in pigs without anhepatic veno-venous bypass.

Objective To investigate anesthesia management for orthotopic liver transplantation (OLT) in pigs without anhepatic veno-venous bypass. Methods 38 healthy pigs were divided into two groups at random:19 donators, 19 receivers. The oral intubation and total intravenous anesthesia were adopted in all pigs. The hemodynamic changes were continuously monitored during the operating phases. The changes of arterial blood gas, blood biochemistry and liver functions were monitored during preanhepatic phase, anhepatic phase and neohepatie phase in 19 receivers. Results The oral intubation was successful in 35 cases, and tracheotomy in 3 cases. The pigs had much tolerance to narcotic, and the volume of narcotic was decreased obviously in anhepatic phase. There were remarkable hemodynamic changes and severe metabolic acidosis during anhepatie phase and neohepatie phase compared with the preanhepatic phase, and temporary serum kalium concentration increased during primary neohepatic phase. The apparent fluctuation of mean arterial blood pressure (MAP), central venous pressure (CVP), heart rate (HR), bases excess (BE), and arterial partial pressure of carbon dioxide ( PaCO2 ) were observed during the period of liver transplantation. Conclusion The oral intubation can be adopted in pigs.Anesthesia can be lighter during the anhepatic phase. Hemodynamics and acid base and electrolyte equilibrium change significantly.Therefore it is very important to monitor hemodynamies and blood biochemistry and arterial blood gas in order to prevent and manage their disturbance during anhepatic to neohepatic phase in orthotopic liver transplantation.