胰肾联合移植术的麻醉及围术期管理

目的: 探讨糖尿病并发终末期肾功能衰竭患者行胰肾联合移植手术的麻醉及围术期管理.方法: 充分术前准备,减轻尿毒症,控制血糖水平,纠正贫血,降低血压,改善心脏功能,积极抗感染;选择硬膜外麻醉,连续监测动脉血压、中心静脉压、心电图和脉搏氧饱和度,定时检测血糖和动脉血气,酌情调控胰岛素用量和扩容速度.结果: 手术开始至吻合肾动脉开放前,循环稳定,动脉血气正常;继后血压和中心静脉压呈较高水平,血糖、尿量和淀粉酶维持在较理想状态.结论: 该手术硬膜外麻醉安全可行,术前充分准备,维持血液动力学稳定和调控血糖水平是围术期管理的关键.

Anesthesia for simultaneous pancreas-kidney transplantation and management of perioperative period

AIM: To explore the anesthesia and management of perioperative period for patients suffering diabetes with end stage renal failure during simultaneous pancreas-kidney transplantation.METHODS: Proper pre-operative preparation included assuaging uremia,controlling blood glucose concentration,alleviating anemia,ameliorating cardiac function,actively controlling infection,adopting epidural anesthesia,monitoring the arterial blood pressure,central venous pressure,electrocardiogram and oxygen saturation continuously,as well as blood glucose concentration and blood gas regularly,and adjusting the dose of insulin and the velocity of transfusion. RESULTS: The circulation was stable and the blood gas was normal from the beginning of the operation to the opening of anastomosed renal artery.The arterial blood pressure and central venous pressure were then at a higher level.The blood glucose concentration,urine volume and serum amylase remained normal level.CONCLUSION: Epidural anesthesia is safe and feasible for the operation.Proper pre-operative preparation,and the stability of hemodynamics and normal blood glucose concentration are critical for the management of perioperative period.