原位肝移植术中血液动力学变化及处理

目的 探讨原位肝移植术中血液动力学的变化和处理。方法 21例原位肝移植手术病人，在无肝期采用体外静脉－静脉转流术，采用Swan-Ganz漂浮导管监测无肝前期、无肝期及新肝期血液动力的变化。结果 无肝前期血液动力学无明显变化。无肝期心排血量明显下降（P＜0.05），但仍维持在正常水平。外周血管阻力和肺血管阻力转流30分钟后明显增加（P＜0.05），其余指标均无显著变化。新肝早期平均动脉压和心排血量明显下降，中心静脉压、肺毛细血管楔压、平均肺动脉压和肺血管阻力明显增加。结论 原位肝移植无肝期采用体外静脉转流术有助于维持血液动力学平稳，胆在新肝早期仍有明显血液动力学变化，需要通过快速输血输液，并将泵管内血灌入体内纠正。

Hemodynamic changes and treatments during liver transplantation

Objective To investigate the hemodynamic changes and treatments during transplantation.Methods During the anhepatic phase,extracorporeal veno venous bypass(EVVB)was utilized in 21 patients undergoig liver transplantation.Hemodynamics were monitored through Swan Ganz catheter during preanhepatic,anhepatic and neohepatic stages.Results CO reduced significantly during EVVB,but still within normal range.SVR and PVR increased significantly at 30 min during veno venous byass.The others had no significant changes during anhepatic stages.MAP and CO reduced,but CVP,PCWP,MPAP and PVR increased significantly in the early reperfusion phase.Conclusions EVVB during the anhepatic phases is helpful to maintain hemodynamics stable,but hemodynamics may be still changed greatly during the initial stage of neohepatic phase,which could be corrected by swift blood and liquid infusion and pumping blood within the pump tubes back to the patient.