胃黏膜pH监测在肝移植围术期应用的研究

目的 探讨胃黏膜pH监测应用于肝移植术围术期的临床意义.方法 30例原位肝移植病人,分别于术前(Tn)、无肝前期30min(T1)、无肝期5 min(T2)、无肝期30 min(T3)、新肝期5 min(T4)、新肝期30 min(T5)、新肝期60 min(T6)、术毕(T7)测定MAP、PCWP、CI、HR、CVP、pHi、Pg-PaCO2、pHa等指标.结果 与术前相比,在无肝期和新肝期5 min、30min时,MAP、pHi、pHa均下降(P<0.05),以新肝期5 min为最低点,而Pg-PaCO2、HR则增高(P<0.05),CVP、PCWP、CI在无肝期下降(P<0.05 ～0.01),在新肝期5 min,30 min则升高(P<0.05).所有指标在新肝期60 min基本恢复至术前水平(P>0.05).结论 肝移植期间出现剧烈的血流动力学波动,无肝期和新肝初期胃黏膜pH明显下降,提示胃肠道灌注不足和缺血缺氧.pHi监测能及时发现胃黏膜缺血缺氧,以便临床采取相应措施,减少并发症.

Application of gastrointestinal mucosa pH monitoring during orthotopic liver transplantation

Objective To assess the clinical value of gastric intramucosal pH(pHi)monitoring during orthotopic liver transplantation.Methods Thirty patients undergoing orthotopic liver transplantation were included in this study.mean artery pressure(MAP),pulmonary capillary wedge pressure(PCWP),cardiac index(CI),heart rate(HR),Central venous pressure(CVP)pHi,Pg-PaCO2 and anerial pH were measured at time-points of pre-operation(T0),30 min before anhepatic phase(T1),5 min(T2)and 30 min (T3)of anhepatic phase,5 min(T4),30 min(T5)and 60 rain(T6)after reperfusion of the transplanted liver and at the end of operation(T7).Results MAP,pHi,pHa decreased and PCO2 gap,HR increased at T2 to T5(P<0.05),and pHi reduced to the lowest level at T4.CVP,PCWP and CI significantly decreased at T2,T3 and obviously increased at T4,T5(P<0.05～0.01).All the indexs at T7 recovered to the level of pre-operation(T0). Conclusion Hemodynamics fluctuates greatly during orthotopic liver transplantation.Significant decrease in pHi indicates gastrointestinal mucosa hypoperfusion,ischemia and hypoxia,and gastrointestinal mucosa pH is a sensitive monitoring item for early detection of gastrointestinal mucosa ischemia and hypoxia.