肝移植病人术中血管外肺水变化的研究

目的 通过脉搏指示剂连续心输出量(PiCCO)监护仪对肝移植病人术中各个阶段血管外肺水(EVLw)的监测,了解其变化规律,分析可能影响EVLW的因素.方法 24例因终末期肝病行原位肝移植手术的患者,左侧肱动脉穿刺并置入5F热稀释导管,连接到PiCCO监护仪,监测血管外肺水、胸腔内血容量指数等参数.分别于手术开始前、无肝前期末、无肝期30 min、新肝期60 min、新肝期120 min和手术结束时记录上述各个血流动力学指标.结果 EVLW术前基础值明显高于正常值,术中虽有逐渐增加的趋势,但与术前相比差异无统计学意义(P>0.05),EVLW与ITBV呈正相关(r=0.822,P<0.05).结论 肝移植病人术中EVLW变化轻微;肝移植术中EVLW明显高于正常值,这主要与循环血容量增加有关.

The changes of extravascular lung water during the perioperative period of orthotopic liver transplantation

Objective To investigate the changes of extravaacular lung water during the perioperative period of orthotopic liver trans-plantation. Methods 24 consecutive patients with end-stage fiver disease undergoing orthotopie liver transplantation (OLT) were studied. In all patients a 5 French fiberoptic catheter with a thermistor was placed in the brachial artery and connected to the PiCCO system. Extravascular lung water (EVLW) and intrathoracic blood volume (ITBV) were monitored. After induction of anesthesia and achievement of stable hemodynamic and respiratory conditions, the baseline values of hemedynamic data, ITBV and EVLW were recorded. The patients were studied during the anhepatic stage, the Ist hour and 2nd hours after reperfusion of the graft. Final measurements of all the values were immediately determined after operation. Results EVLW remained statistically unchanged during the whole study period in all patients though all of them were increased, compared to normal values. EVWL was positively correlated with ITBV (r = 0. 822, P < 0. 05). Conclusion The changes of EVLW during perioperative period of orthotopic fiver transplantation were very little. Circulative volume overload may be perhaps the most important cause of the increase of EVLW.