原位肝移植术中胃肠黏膜循环的变化

目的:探讨原位肝移植术期间机体胃肠黏膜循环的变化。方法:30例原位肝移植病人,分别于术前、无肝前期30min、无肝期5min、无肝期30min、新肝期5min、新肝期30min、新肝期60min、术毕测定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、30min时,MAP、pHi、pHa均下降(P<0.05),而Pg-PaCO2、HR则增高(P<0.05);CVP、PCWP、CI在无肝期下降(P<0.05),在新肝期5、30min则升高(P<0.05)。所有指标在新肝期60min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,胃肠道灌注明显不足,缺血缺氧以无肝期和新肝期最为严重,随着门静脉的开放和新肝功能的恢复,胃肠道黏膜灌注及缺血得到改善。

The changes in the circulation of gastrointestinal mucosa during orthotopic liver transplantation

Objective To explore the changes in the circulation of gastrointestinal mucosa during orthotopic liver transplantation.Methods MAP,PCWP,CI,HR,CVP,pHi,Pg-PaCO2,and pHa were detected in thirty patients at different time points including preoperation,30 min of preanhepatic phase,5 and 30 min of anhepatic phase,5,30,and 60 min of neohepatic phase,and completion of the operation.Results As compared to those in preoperation,MAP,pHi,and pHa were decreased during the anhepatic phase and at 5 and 30 min of the neohepatic phase(P < 0.05),while Pg-PaCO2 and HR were increased(P < 0.05).CVP,PCWP,and CI were declined in the anhepatic phase(P < 0.05)but elevated at 5 and 30 min of the neohepatic phase(P < 0.05).All of the measured indices approximately returned to their preoperative levels at 60 min of the neohepatic phase(P > 0.05).Conclusions A dramatic fluctuation in hemodynamics occurs during orthotopic liver transplantation,resulting in a marked perfusion deficiency in gastrointestinal mucosa,especially in the anhepatic and neohepatic phase.The hypoperfusion and ischemia of the gastrointestinal mucosa improve with the opening of portal vein and recovery of hepatic function.