肝移植术中心跳骤停的五例临床分析

目的探讨肝移植术中心跳骤停的发生原因及预防措施。方法回顾性分析肝移植术中发生心跳骤停的5例患者的临床资料。结果240例肝移植中,5例(2.1%)术中出现心跳骤停,均发生在供肝恢复血流后3~6min,持续3~8min,2例复苏失败;供肝血流恢复时,肺动脉压和中心静脉压均明显升高,血钙降低,出现低体温,3例合并酸中毒,2例合并高钾血症,1例动脉血和呼气末的CO2差值达47mmHg。结论肝移植术中心跳骤停的发生可能与供肝血流恢复后的血电解质和酸碱平稳紊乱以及体温过低有关,应采取综合预防措施。

Clinical analysis of cardiac arrest in 5 cases during liver transplantation

Objective To analysis the causes of cardic arrest during liver transplantation, and investigate the preventive measures. Methods Clinical records about 5 patients with cardiac arrest in liver transplant were studied retrospectively. Results Occurrence of cardiac arrest was 2.1 % (5/240). All the events happened at 3-6 min after graft reperfusion, and arrest lasted 3-8 min. Two patients died of resuscitation failure. After graft reperfusion, CVP and MPAP were much high in 5 patients. All of them had hypothermia and hypocalcemia. Three of them also had acidosis and two complicated with hyperkalemia. In one case, the difference between PaCO_2 and P_ETCO_2 was 47 mm Hg. Conclusion Many factors, such as disturbances of electrolyte and acid-base equilibrium or hypothermia, seemed to have some contribution to cardiac arrest occurrence after reperfusion. Various methods should be used to counter it.