原发性肝癌与肝硬化患者在肝移植术中血液动力学、酸碱平衡和电解质的变化及处理

Changes and treatments of hemodynamics, pH and electrolytes during the liver transplantation of two different liver diseases

关键词:  肝移植  血液动力学  酸碱平衡  电解质

Key words:  transplantation of liver  hemodynamics  acid-base balance  electrolyte

摘要:

［目的］ 观察分析不同原发肝脏疾病患者肝移植术中血液动力学、酸碱平衡和电解质变化的原因及处理方法。［方法］ 将择期行同种异体肝移植患者按原发疾病分组：原发肝癌肝移植组（A组，29例），平均年龄（49±7）岁，体重（60±12）kg，ASAⅡ-Ⅲ级；肝硬化肝移植组（B组，26例），平均年龄（56±9）岁，体重（58±15）kg，ASAⅢ-Ⅳ。两组患者心、肺、肾功能术前检查正常，两组术式均为改良背驮式肝移植术式。观察记录两组麻醉过程中血液动力学、电解质以及酸碱平衡变化及处理结果。［结果］ 诱导期肝硬化组血液动力学变化明显，插管后SBP、DBP、HR均升高，组内比较差异有统计学意义（P<0.05），与原发肝癌组组间比较差异亦有统计学意义（P<0.05）；原发肝癌肝移植组无肝期、门静脉开放即刻血液动力学变化明显，MAP、CVP、PAWP、CO 、CI下降与肝硬化肝移植组组间比较差异有统计学意义（P<0.05）；原发肝癌肝移植组酸碱平衡和电解质在新肝期变化明显，钾离子升高与肝硬化肝移植组组间比较（P<0.05）差异有统计学意义；术中原发肝癌肝移植组较肝硬化肝移植组的血液动力学调整略复杂。［结论］ 开放前预处理和静脉交通支的扩张开放可能是肝硬化移植组在无肝期和新肝期血液动力学、酸碱平衡和电解质的变化较小的原因。

Abstract:

［Objective］ This study aimed to evaluate hemodynamics, pH and electrolytes during liver transplantation of primary liver carcinoma or liver cirrhosis.［Methods］ This is an open-labeled study. 55 patients, aged 42~65 years, undergoing piggyback liver transplantation with ASA Ⅱ-Ⅳ were recruited. They were divided into two groups due to the different original disease: A) primary liver cancer (n=29), and B) cirrhosis of liver (n=26). No difference was found between two groups on the demographic data. The ASA grade of two groups were Ⅱ-Ⅲ and Ⅲ-Ⅳ respectively. Vital signs (SBP and DBP, HR, RR and SpO2), pH and concentration of K+ and Ca²⁺ were recorded before, during and after the surgery. ［Results］ No difference was found on demographic data. During the induction period, hemodynamics in group B changed more than group A(P<0.05). In the non-liver and post-opening of portal vein period, hemodynamics changed more in group A than that in group B, and MAP, CVP, PAWP, CO and CI in group A were significantly lower than those in group B (P<0.05). During reperfusion stage, concentration of K⁺ group A was higher than that in group B and significant difference was found (P<0.05).［Conclusion］ The opening of portal vein and inferior vena cava maybe result in the less change of hemodynamics, pH and electrolytes during the liver transplantation of cirrhosis of liver.