| 摘要: |
| 目的：总结再次肝移植手术的麻醉管理方法。方法：回顾我院20例再次肝移植患者的临床麻醉资料,全组患者采用静吸复合全身麻醉，术中监测有创动脉压（ABP）、心电图（ECG）、中心静脉压（CVP）、肺动脉压（PAP）、肺小动脉楔压（PAWP）、连续心输出量（CCO）、心脏指数（CI）、呼气末二氧化碳分压（PetCO2）、听觉诱发电位指数（AEPI）、中心体温（T）、尿量等；采用脉搏指示连续心输出量(PiCCO)技术监测全心舒张末期容积（GEDV）、胸腔内血容积（ITBV）、血管外肺水（EVLW）、全身血管阻力（SVR）、每搏量变异（SVV）等。统计距离首次肝移植时间、合并腹腔感染或多系统器官衰竭（MOSF）情况、再次手术方式。统计两次手术时间、无肝期时间、出血量、输血量，以及羟乙基淀粉（万汶）、白蛋白、纤维蛋白原、凝血酶原复合物和碳酸氢钠使用量；统计再次移植患者术前凝血酶原时间、国际标准值对照值，术前肌酐、术前胆红素，并与首次移植的相应指标进行比较。结果：20例再次肝移植患者无麻醉死亡，麻醉手术期血流动力学基本平稳，尿量、电解质、酸碱平衡基本稳定。再次移植手术时间明显延长，再次肝移植术中出血量、输血量、纤维蛋白原使用量、凝血酶原复合物使用量、碳酸氢钠使用量明显增多。结论：再次肝移植手术的麻醉管理技术相当复杂, 对病情的充分估计和对手术的了解、术中的细心观察和及时的正确处理是再次肝移植术麻醉管理的重点。 |
| 关键词: 麻醉 肝移植；再手术 |
| DOI：10.3724/SP.J.1008.2007.00992 |
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| 基金项目:上海市卫生局面上项目（2007076）. |
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| Anesthetic management for liver re-transplantation |
| XU Hai-tao, SHI Xue-yin*, YUAN Hong-bin, HE Xing-ying, YE Jun-qing, JIANG Jing-jing |
| (Department of Anesthesiology, Changzheng Hospital, Second Military Medical University, Shanghai 200003, China) |
| Abstract: |
| Objective：To summarize our experience on anesthetic management for liver re-transplantation. Methods: The clinical data of 20 patients who received liver re-transplantation under general anesthesia were retrospectively analyzed. General anesthesia was given to all patients. Ambulatory blood pressure (ABP), electrocardiogram (ECG), central venous pressure (CVP), pulmonary artery pressure (PAP), pulmonary artery wedge pressure continuous cardiac output (CCO), cardiac index (CI), partial pressure of end-tidal carbon dioxide pressure (PetCO2), auditory evoked potentials index (AEPI), body temperature (T), and urine volume were continuously monitored during the operation. Pulse-induced contour cardiac output (PiCCO) technology was used to measure global end-diastolic volume (GEDV), intrathoracic blood volume (ITBV), extravascular lung water (EVLW),systemic vascular resistance(SVR),and stroke volume variation（SVV) . The following data of patients, including the periods between the 2 operation, the presence of abdominal infection and multiple organ system failure (MOSF), the mode of re-operation, the operation duration, non-liver time, blood loss, blood transfusion, prothrombin time (PT), international normalized ratio (INR), preoperative creatinine, preoperative bilirubin, and the use of volven, albumin, 5% sodium bicarbonate, fibrinogen and thrombin, were all investigated and compared between the 2 operations. Results: All the 20 patients survived after liver re-transplantation. During the operation the hemodynamic state, urine volume, electrolytes, and acid-base balance were all stable. The duration of the re-operation was significantly longer compared with that of the first operation (P<0.05), and the blood loss, blood transfusion, and the used of fibrinogen, thrombin and 5% sodium bicarbonate were all significantly more than those of the first operation (P<0.05).Conclusion: Anesthetic management for liver re-transplantation is very complicated; better understanding of patients condition and operation, careful observation during operation, and correct management in time are the keys for successful operation. |
| Key words: anesthesia liver transplantation re-operation |
