背驮式肝移植无肝期的细分与容量管理对策

目的探讨对背驮式肝移植手术的无肝期做进一步细分和容量管理的对策。方法67例背驮式肝移植手术患者,无肝期划分为门静脉阻断期和下腔静脉阻断期,以尿量为指标,采用不同的输液管理方法。结果与无肝前期比较,下腔静脉阻断期尿量显著降低,新肝期尿量显著增加;下腔静脉阻断期和新肝期少尿发生率显著增多、少尿纠正率显著降低;9例达到ARF诊断标准、占13.4%,术中无肝期时间、术中低血压时间、术后低血压时间无显著延长,但出血量显著增多、术中少尿时间显著延长。结论将无肝期再细分,有区别地补充容量维持正常尿量是可行的,术中血液动力学比较稳定,术后肾脏功能恢复比较满意。

Subdivision and capacity management of anhepatic phase in Piggy-back liver transplantation

Objective To make further subdivision of anhepatic phase in Piggy-back liver transplanta-tion and investigate capacity management at every phase.Method The 67 patients undergoing Piggy-back liver transplantation surgery were selected.The anhepatic period was partitioned into portal vein cross-clamping period and inferior vena cava cross-clamping period.Result By contrast with that in anhepatic prophase,urinary volume decreased in inferior vena cava cross-clamping period and that in neo-liver period was increased significantly;oliguria incidence rate was increased and oliguria rectification rate was decreased significantly in inferior vena cava cross-clamping period and neo-liver period;9 cases(13.4%)fited diagnostic criteria of ARF.The time of anhepatic phase,hypotension during operation and hypotension after operation were no prolongation notably.But bleeding volume increased and oliguria time prolonged notably during operation.Conclusion It is feasible to make anhepatic phase subdivision and maintain urinary volume by adding capacity discretely.Haemodynamics during operation is stable and recovery of renal function after operation is satisfactory relatively.