摘要
目的探讨重型乙型肝炎(乙肝)与其他肝病患者原位肝移植围术期全身氧代谢变化的特点。方法12例重型乙肝患者为试验组,10例其他肝病患者为对照组。以咪唑安定、异丙酚、芬太尼、维库溴铵诱导全麻,术中吸入异氟醚维持麻醉,维库溴铵维持肌松,行改良背驼式原位肝移植术。左桡动脉穿刺测有创动脉压,右颈内静脉穿刺置入漂浮导管。分别于术前、无肝前10min、无肝期25min、新肝期30min和术毕监测动脉和混合静脉血氧分压(PaO2和PvO2)、动脉和混合静脉血氧含量(CaO2和CvO2)及动静脉血氧含量差(CavO2)、氧供(DO2)、氧供指数(DO2I)、氧消耗(VO2)、氧耗指数(VO2I)、氧摄取指数(O2EI)和氧摄取率(O2ER)。结果1试验组:与术前相比,无肝前期PvO2上升,CavO2、O2EI、O2ER下降,DO2和VO2无明显变化;无肝期DO2、DO2I、VO2和VO2I均明显下降,DO2、VO2分别下降43%和21%,O2EI和O2ER均明显上升;新肝期PvO2上升,DO2和DO2I明显上升,VO2和VO2I回升至术前水平;术毕时DO2和DO2I依然高于术前水平。2对照组:无肝前期PvO2上升,DO2和VO2无明显变化,O2EI和O2ER下降;无肝期DO2、DO2I、VO2和VO2I均明显下降,DO2下降25%,VO2则下降12%;新肝期PvO2上升,CavO2下降,DO2、DO2I明显上升,VO2和VO2I回升至术前水平;术毕时DO2和DO2I依然高于术前水平。结论肝移植围术期中,全身DO2变化大于VO2变化;重型乙肝患者的全身DO2和VO2变化较其他肝病患者剧烈。
Objective To investigate the changes in oxygen metabolism in peri -operative stages in hepatitis B gravis and non -hepatitis B gravis undergoing orthotopic liver transplantation （OLT）. Methods Twelve patients undergoing OLT for hepatitis B gravis （experimental group） and 10 patients without hepatitis B gravis （control group） were enrolled for study. Anesthesia was induced by propofol, fentanyl and norcurium, and maintained with isofluence. Arterial catheter was inserted into the left radial artery. Swan- Ganz catheter was inserted through the right internal jugular vein. Arterial partial pressure of oxygen （PaO2）, mixed venous partial pressure of oxygen （P v^-O2）, arterial oxygen content （CaO2）, mixed venous oxygen content （C v^-O2）, arterial -venous oxygen content difference （Ca-vO2）, oxygen delivery （DOe）, index of oxygen delivery （DO2I）, oxygen consumption （VO2）, index of oxygen consumption （VO2I）, index of oxygen extract （O2EI）, oxygen extract rate （O2ER） were determined before skin incision （T1）, 10 minutes before anhepatic phase （T2）, 25 minutes after liver was removed （anhepatic phase, T3）, 30 minutes in neohapitic phase （T4）, and the end of operation （TS）. Results ①In the experimental group, P v^-O2 increased,Ca - vO2 decreased, DO2 and VO2 showed no change, and O2EI and O2ER decreased in T2. In preanhepatic period, P rOe increased, Ca - vO2 decreased, DO2 and VO2 did not change. In anhepatic period, DOe, DO2I, VO2 and VO2I decreased obviously, DO2 decreased by 43%, while VO2 decreased by 21% ,and O2ER increased obviously. In reperfusion period, PaO2 and P v^-O2 increased, CaO2 and C a - vO2 decreased, DOe and DO2I increased, VO2 and VO2I recovered to base level. After termination of operation, P v^-O2, DOe, DO2I were still high. ②In the control group：P v^-O2 increased, O2EI and O2ER decreased, but no significant changes were found in DOe and VO2 in T2. DO2, DO2I, VO2, and VO2I all decreased in T3, while DO2 reduced by 25% and VO2 reduced by 12% . In T4, P v^-O2, DO2 and DO2I all increased, while Ca - vO2, VOe and VO2I reached the pre - operative levels in T4. DO2 and DO2I levels were higher than those of preoperation in TS. Conclusion The decrease in DO2 is more obvious than VO2 in anhepatic period during OLT in hepatitis B gravis patients. In neohepatic period, DO2 increases while VO2 returns to base level.
出处
《中国危重病急救医学》
CAS
CSCD
北大核心
2005年第10期595-598,共4页
Chinese Critical Care Medicine
基金
国家自然科学基金资助项目(30271254)
广东省科技计划项目(2004B35001005)
