肝移植不同术式对血流动力学的影响

目的比较肝移植不同手术方式对血流动力学的影响。方法择期原位肝移植病人86例,根据手术方式分为三组。A组接受经典标准式肝移植(38例),B组接受经典改良式肝移植(12例),C组接受背驮式肝移植(36例)。左桡动脉和右股静脉置管连续监测平均动脉压(MAP)和下腔静脉压(ICVP);经右颈内静脉放置肺动脉漂浮导管,连续监测中心静脉压(CVP)、平均肺动脉压(MPAP)、心脏指数(C I)、外周血管阻力(SVR)和肺血管阻力(PVR)。结果无肝前期三组间血流动力学变化无差异。无肝期心率、SVR和PVR上升,C I下降,MAP维持稳定,三组间变化无明显差异。A、B组CVP下降和ICVP升高均显著大于C组(P<0.01)。新肝期开始,A、B和C三组再灌注综合征发生率分别为34.2%、16.7%和25.0%;A组MAP和C I低于B组和C组,而CVP高于B组和C组(P<0.05)。至新肝期5 m in,除A组C I仍低于B和C组(P<0.05),其他指标三组间无差异。结论对血流动力学影响,经典标准式肝移植最大,经典改良式肝移植最小。

Effects of Different Ways of Liver Transplantation on Hemodynamics

Objective To investigate the effects of different ways of liver transplantation on hemodynamics.Methods Eighty-six patients undergoing elective liver transplantation were divided into three groups according to the ways of surgery: group A received standard classic liver transplantation(38 cases),group B received modified classic liver transplantation(12 cases) and group C received piggyback liver transplantation(36 cases).Left radial artery and right femoral vein were catheterized to continuously monitor mean artery pressure(MAP) and inferior vena cava pressure(IVCP).Right internal jugular vein was inserted Swan-Ganz catheter to continuously monitor central venous pressure(CVP),mean pulmonary artery pressure(MPAP),cardiac index(CI),systemic vascular resistance(SVR) and pulmonary vascular resistance(PVR). Results There were no significant differences in hemodynamics among the three groups before anheptic period.During anhepatic period,HR,SVR and PVR increased,while CI decreased,and MAP maintained stable in three groups. CVP decreased and ICVP increased in three groups,but the changes in group A and B were much greater than those in group C(P<0.01).At the beginning of neohepatic period,the incidence of reperfusion syndrome was 34.2%,16.7% and 25.0%,respectively.MAP and CI were much lower and CVP was much higher in group A than those in group B and C(P<0.05).At 5 min of neohepatic period,there were no significant differences in hemodynamic parameters apart from that CI in group A was still much lower than that in group B and C(P<0.05). Conclusion Standard classic liver transplantation has the most effect on hemodynamics,while modified classic liver transplantation has the least.