成人-成人活体肝移植供体右半肝切除的麻醉管理

目的：总结麻醉管理对活体肝移植供体右半肝切除安全性的影响。方法：回顾总结了2007年5月-2007年11月连续完成的67例成人-成人间活体肝移植供体右半肝切除的麻醉管理。术前对供体全身一般情况和重要脏器功能行全面检查和评估。测定整个肝脏及右半肝的体积，术前计算切除右半肝的体积和质量。麻醉诱导：咪唑安定0．04mg／kg，舒芬太尼1μg／kg，异丙酚1-2mg／kg，维库溴铵0．1mg／kg。术中静脉间断注射舒芬太尼和维库溴铵持续泵入异丙酚，间断吸入七氟烷维持麻醉。常规监测包括心电图，血氧饱和度，有创动脉压，中心静脉压，呼末二氧化碳分压，尿量，体温等。所有患者术后带静脉镇痛泵回ICU。结果：手术时间（653±133）min。12例患者术毕拔管返ICU，其余监护室拨管。平均带管时间（8．6±1．8）h，平均ICU停留时间（17±09）d，平均住院时间（25±8）d。平均失血量（494±199）ml，4例患者输自体回收血400ml，术中输液包括晶体、胶体、输液总龌（4050±943）ml，其中醋酸盐林格氏液（2142±643）ml，聚盟胶肽（1933±485）ml，晶胶比1：1，尿壁（1648±868）ml。术前、术毕及术后第1天血红蛋白含量分别为（149±14）g/L，（129±18）g/L，（137±17）g／L，术前，术毕及术后第1天血乳酸含量分别为（1．5±09）mmol/L，（64±29）mmol／L，（27±10）mmol／L。切肝开始CVP（2．7±1．4）mmHg，术毕CVP（6.1±1.2）mmHg。切除右肝体积837（534-1430）cm^3，右肝重量728（540—1258）g，GBWR（0.92—1.68）％。所有供体均顺利康复出院。结论：成人-成人间活体肝移植供体右半肝切除麻醉方法是安全的术中血流动力学稳定，围术期无供体死亡及与麻醉相关的并发症。

Anesthesia Management of Right Hepatectomies in Adult-to-Adult Living-Donor Liver Transplantation

Objective： To summarized the effects of anesthesia to the safety of right hepatectomies in adult-to-adult living-donor liver transplantation. Methods： We reviewed retrospectively the anesthetic management in March 2007- Nov 2007 in adult-to-adult right-lobe living-donor liver transplantation. ASA Ⅰ-Ⅱ, A graft-recipient body weight ratio of （0.92-1.68） %. Pre-operation investigations were general. The volume and weight of the resected right lobe was calculated. Anesthesia was induced with midazolam 0.04mg/kg, sufentanil 1μg/kg, propofol 1-2mg/kg, vecuronium 0.1mg/kg. Anesthesia was maintained with sufentanil, propofol, vecuronium and isoflurane. Routine anesthetic monitoring included electrocardiography, pluse oximetry, invasive blood pressure, central venous pressure, ETCO2, urine output and temperature. Results： The operation time was （653±133） min. The mean extubation time was （8.6±1.8） h. Twelve were extubated in the operating room immediately after surgery, the others were extubated in the intensive care unit. Blood loss was （494±199） ml, four received autologous blood 400ml. Total urine output was （1647±868） mh The pre-and immediately postoperative and the first postoperative day, the hemoglobin was （149±14） g/L, （129±18） g/L and （137±17） g/L. The pre-and immediately postoperative and the first postoperative day, the lactate concentration was （1.5±0.9） mmol/L, （6.4±2.9） mmol/L, （2.7±1.0） mmol/L Pre-operative CVP （2.7±1.4） mmHg, immediately postoperative CVP （6.1±1.2） mmHg. The volume and weight of the resected right lobe was 837 （534-1430） cm^3, and 728 （540-1258） g. Conclutions： The anesthesia of right-lobe living-donor surgery was safety without hemodynamic instability, There was no morbidity or mortality related with anesthesia.