终末期肝衰竭患者肝脏移植术后血流动力学变化

目的 :观察终末期肝衰竭患者肝脏移植术后的血流动力学变化。方法 :5例终末期肝衰竭患者行肝脏移植手术 ,监测其手术后 3日内中心静脉压 (CVP)、肺动脉压 (PAP)、肺小动脉楔压 (PAWP)、心排血量 (CO)和平均动脉压 (MAP)等参数的变化。结果 :患者术后进入 ICU当时的 MAP、肺毛细血管楔压 (PCWP)和 CVP均明显低于正常参考值 ,心率 (HR)显著增快 ;术后 3日内经过积极扩容 ,MAP、PCWP和 CVP显著升高(P均 <0 .0 1)。入 ICU后 8小时内的心脏指数 (CI)轻度降低 ,但与术后 2 4、4 8小时的 CI值比较均无显著性差异 (P均 >0 .0 5 )。入室后 8小时内的外周血管阻力指数 (SVRI)、肺血管阻力指数 (PVRI)轻度降低 ;术后 3日内上述指标逐渐恢复正常。结论 :终末期肝衰竭患者肝移植术后血流动力学不稳定 ,出现明显的血容量不足表现 ,如不及时纠正可能导致脏器灌注不足 ,乃至器官功能衰竭 ,因此 ,密切监测其血流动力学的变化 ,估计其血容量不足状态并予充分纠正 ,是肝移植患者安度围手术期的关键

Changes in hemodynamics in end stage liver failure patients after liver transplantation

Objective:To investigate the changes in hemodynamics in end stage liver failure patients after liver transplantation.Methods:Five patients with liver transplantation were included in this study.SwanGanz catheters were inserted and central venous pressure (CVP),mean pulmonary arterial pressure (MPAP), pulmonary capillary wedge pressure (PCWP),cardiac output (CO),mean arterial pressure (MAP),systemic vascular resistance index (SVRI),pulmonary vascular resistance index (PVRI),heart rate (HR) were measured from 1 to 3 days after the operation.Results:MAP,PCWP,and CVP decreased and HR increased after the admission to ICU,and then they were increased within 3 days.Cardiac index(CI) showed no marked changes within 3 days.SVRI and PVRI were decreased at the admission,and then were improved in the next 3 days.Conclusions:In end stage liver failure patients with liver transplantation,the hemodynamics is unstable,indicating hypovolemia.It is necessary to calculate the volume deficit and determine the resuscitation volume.