| 董刚 任波 郭晓东 徐晨 刘芳婷 李晶 刘霞 毕振华 刘振文.不同灌注方法对原位肝移植麻醉的临床效果分析[J].,2014,14(7):1297-1299 |
| 不同灌注方法对原位肝移植麻醉的临床效果分析 |
| Clinical Analysis about Different Methods of Retrograde Perfusion forAnesthesia on the Orthotopic Liver Transplantation |
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| DOI： |
| 中文关键词: 经典非转流肝移植 麻醉 灌注方法 再灌注综合征 |
| 英文关键词: Orthotopic liver transplantation Anesthesia Reperfusion Post-reperfusion syndrome |
| 基金项目:院长创新基金项目（YNKT2010011） |
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| 中文摘要: |
| 目的：观察下腔静脉逆灌注法与常规门静脉正向灌注法应用于经典非转流原位肝移植手术的临床效果，并比较两种灌注法
对新肝期再灌注后综合征的影响。方法：回顾性分析我院行经典非转流肝移植手术的患者60 例，按照灌注方法的不同分为两组:
A 组(30 例)采用下腔静脉逆灌注法；B组(30 例)采用门静脉正向灌注法。比较两组患者围手术期的血流动力学指标、体温、内环境
的改变等情况。结果：①分别在新肝开放即刻、新肝期5 分钟及15 分钟观察两组患者的平均动脉压、肺动脉压楔压、心率变化程
度及心脏指数，A组均小于B 组，差异有统计学意义（P<0.05）；②分别于新肝期5 分钟及15 分钟观察两组患者的中心静脉压，A
组低于B 组（P<0.01）；③观察开放时两组患者的最低温度，A 组高于B 组（P<0.01）；④观察血管活性药物用量，A组少于B 组，差
异有统计学意义（P<0.05）。结论：经典非转流肝移植术中，采取逆灌注方法可减少术后再灌注综合征的发生。两种灌注方式均需要
加强对血流动力学、体温、酸碱平衡的监测与调整，做到针对性的麻醉管理。 |
| 英文摘要: |
| Objective:To observe the applications of different retrograde perfusion methods on the orthotopic liver transplantation
without venous bypass, and to compare the clinical effects on the post reperfusion syndrome.Methods:Sixty patients with orthotopic
liver transplantation who were treated in our hospital were selected and randomly divided into two groups according to different
perfusion methods. Group A with 30 cases, were unclamped before portal anastomosis, while group B with another 30 cases were
performed the normal perfusions via portal veins. The hemodynamic parameters, body temperature, changes of internal environment and
fluid therapy of patients were compared between the two groups. Results:① The changes in systolic blood pressure, diastolic blood
pressure and heart rate in group A were less than those of group B at the beginning of neohepatic phase, the fifth minutes and the fifteenth
munites respectively, and there were statistically significant differences between two groups(P<0.05); ②The central venous pressure was
significantly lower than that of group B at the fifth and tenth minutes of neohepatic phase, and there was statistically significant difference
between two groups (P<0.05); ③At the early neohepatic stage, the body temperature in group A were significantly lower than that of the
group B. ④ The requirement of vasoactive drugs in the group A was significantly smaller than that of the group B, and there was
statistically significant difference between two groups (P<0.05).Conclusion:Compared with traditional perfusion, the retrograde
perfusion in the orthotopic liver transplantation is more useful to relieve the post reperfusion syndrome. It is suggested that the
hemodynamics, body temperature, and internal environment should be emphasized to monitor and regulate the OLT. |
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