体外静脉-静脉转流在原位肝移植术中的应用

目的　总结转流过程中的循环、代谢变化 ,并对转流的作用进行探讨　方法　对 5 4例次行静脉 静脉转流的肝移植术患者的临床资料进行分析。　结果　转流过程中及转流后心率(HR)、平均动脉压 (MAP)、中心静脉压 (CVP)、心输出量 (CO)、动脉氧分压 (PaO2 )、二氧化碳分压(PaCO2 )、血K+、Na+、Ca2 +、BUN值与转流前相比均无明显变化。pH值在转流后 15min较转流前明显降低 (P <0 0 5 ) ,乳酸水平在转流 30min、6 0min和转流后 15min比转流前均有明显增高 (P <0 0 5 )。转流 6 0min时ACT较转流前延长 (P <0 0 5 ) ,血肌酐值术后第 1天比转流前有显著提高 (P <0 0 5 )。　结论　体外静脉 静脉转流可以使肝移植手术无肝期的血液循环动力学和代谢处于相对稳定状态 ,但也存在增加手术和肝缺血时间、增加费用等一些问题。

Venovenous bypass in 54 liver transplantations

Objectives To summarize hemodynamic and metabolic changes during bypass, and to evaluate the bypass in liver tansplantation. Methods Fifty-four patients underwent orthotopic liver transplantation with venovenous bypass from May 2000 to May 2002. Their clinical features were analysed. Results SHR, MAP, CVP,CO, PaO 2, PaCO 2, serum K+,Na+,Ca 2+, BUN values were not significantly changed duving bypass. Compared to the pre-bypass stage, pH was decreased in the post-bypass stage (P<0.05), serum lactic acid value was increased in the bypass and post-bypass stage(P<0.05), active clotting time was increased in the bypass stage(P<0.05), serum creatinine value was increased on first postoperative day (P<0.05). Conclusions Venovenous bypass could improve hemodynamic and metabolic stability in the anhepatic phase, but it also could increase operation duration, liver ischemic time and cost.