容量性肺动脉导管用于原位肝移植术监测

目的 观察原位肝移植术中容量性肺动脉导管的监测指标,评价其临床意义.方法 择期施行肝移植的终末期肝病病人20例,于静脉和吸入复合全身麻醉下,从右颈内静脉放置容量性肺动脉导管(Swan-Ganz CCOMBoV导管),分别在麻醉后、无肝期15 min、无肝期30 min、新肝期15 min、术毕前30min记录心率、平均动脉压、中心静脉压、肺毛细血管楔压、心脏指数、每搏指数、体循环阻力指数、肺循环阻力指数、右心室舒张末期容积指数.结果 与麻醉后相比,平均动脉压在新肝期15 min下降(P＜0.05),其余时间点基本稳定;肺毛细血管楔压、中心静脉压、右心室舒张末期容积指数、心脏指数及血氧饱和度在无肝期显著下降(P＜0.01);各时间点内右心室舒张末期容积指数与心脏指数均相关(P＜0.01),肺毛细血管楔压仅在无肝期与心脏指数显著相关(P＜0.01),中心静脉压在新肝期及术毕前与心脏指数相关(P＜0.01).结论 容量性肺动脉导管检查能在肝移植术中提供全面实时的血流动力学指标,有助于评估循环功能状态,指导血管活性药物应用及容量治疗.

Application of volumetric pulmonary artery catheters in liver transplantation

Objectives To evaluate the application of volumetric pulmonary artery catheters in liver transplantation. Methods Twenty patients suffered from end phase hepatopathy and they were scheduled for liver transplantation under general anesthesia, volumetric pulmonary artery catheters were placed through right internal jugular vein, the hemodynamic data, including heart rate(HR), mean arterial pressure (MAP),central venous pressure (CVP), pulmonary capillary wedge pressure (PCWP), cardiac index (CI), stroke volune index (SVI), systemic vascular resistance index (SVRI), pulmonary vascular resistance index (PVRI), right ventricular end-diastolic volume index (RVEDVI), were recorded at five measurement points of after anesthesia, anhepatic phase 15 min, anhepatic phase 30 min, reperfusion phase, before end of the surgery. Results Compared with postanesthesia value, MAP was decreased in anhepatic phase (P<0.05), PCWP,CVP, RVEDVI, CI and SvO2 were apparently decreased in anhepatic phase(P<0.01). RVEDVI was apparently correlated with CI at all time points(P<0.01), PCWP was apparently correlated with CI in anhepatic phase(P<0.01),CVP was apparently correlated with CI in reperfusion phase (P<0.01). Conclusions In liver transplantation, volumetric pulmonary artery catheters can provide overall hemodynamic data which assists in evaluation of circulation functions and guides drug and volume treatment.