非静脉转流下原位肝移植围手术期循环和电解质变化的观察

目的观察非静脉转流下,经典原位肝移植病人围术期电解质浓度和血流动力学变化。方法9例原位肝移植病人在非静脉转流下,行气管插管静吸复合麻醉,术中经颈静脉双腔管持续监测CVP,桡动脉置管监测ABP,于手术各期定时抽取桡动脉血行血气分析,测定钠、钾、钙浓度;常规持续监测HR,SpO2,ETCO2及体温。结果整个围手术期血钙持续偏低,无肝期和再灌注前期尤为明显。无肝期前期(5 m in)及再灌注前期(5 m in)血钾轻度上升,无肝期中期(30 m in)及再灌注中期(30 m in)血钠轻度上升,但极少超出正常范围,病人血流动力学稳定后逐渐恢复诱导后水平。进入无肝期后,大部分病人血压一过性明显下降,其余时间段均较平稳。结论非静脉转流原位肝移植,无肝期及再灌注期应注意纠正低血钙,无肝期前期(5 m in)及再灌注前期(5m in)应警惕高血钾发生。进入无肝期前应适当扩容,无肝期中应用血管活性药物维持血压,及时根据病人失血量及血球压积补充血容量,尽可能维持围术期循环稳定,防止再灌注前期严重酸中毒的发生。

The changes of hemodynamics and electrolyte in orthotopic liver transplantation without venovenous bypass

Objective To investigate the clinical significance of the changes of hemodynamics and electrolyte during orthotopc liver transplantation.Methods We studied 9 patients undergoing elective orthotopic liver transplantation without venovenous bypass,drew out arterial blood for monitoring arterial blood gas tensions,Na~ ,K~ ,Ca~(2 ) and observed changes in hemodynamics and electrolyte.Results In most patients,arterial pressure significantly decreased at the prophase of the anhepatic phase,and tended to normal range in other phases.The concentration of calcium maintained a low-level during the whole surgery.During the prophases of the anhepatic phase and neo-hepatic phase,there was a light hyperkalemia,and the concentration of natrium slightly increased since 30 minutes after the anhepatic phase and neohepatic phase,but insensibly exceeded normal range.With resuming of the stability of hemodynamics,these changes had followed.Conclusion We shoud give our attention to correct the occurrence of the hypocalcemia during the forepart of the anhepatic phase and neo hepatic phase,and care for the hyperkalemia 5 minutes after the block of liver blood purveyance and revascularization of liver.The lock of body capability shoud be recruit duly according to the lose of blood and hemacytometer changes.In order to prevent serious academia and maintain the stability of hemodynamics and electrolyte,vasoconstrictor shoud be used carefully during the anhepatic phase.