摘要
目的 探讨非转流原位肝移植术对胃黏膜pH(gastricintraumucosalpH ,pHi)的影响。 方法 选择 2 0例行非转流原位肝移植术的患者 ,采用胃管法 ,分别于入室、无肝期前 2 0min、无肝期 30min、新肝期 30min、术后 2、2 4h抽取胃液 3～ 5mL ,分析胃液的PCO2 ,同时在以上各时点监测动脉血PaCO2 、PaO2 、pH、HCO3 -和BE ,并代入Henderson Hasselbach公式计算pHi。结果 pHi在无肝期 30min、新肝期 30min均显著低于术前水平 (P <0 .0 1) ,且新肝期 30minpHi为最低点。术后 2h虽较术前有所回升 ,但仍有显著性差异 (P <0 .0 5 )。结论 肝移植阻断下腔静脉后胃黏膜有明显的缺血低灌注现象。随着阻断时间延长 ,胃黏膜低灌注、酸中毒的症状加重。提示术前选用抗酸药物治疗 ,术中减少血流动力学的波动、尽量缩短无肝期的时间对提高pHi、保护胃黏膜、减少术后并发症、改善预后有一定的临床意义。
Objective To investigate the ch an ges of gastric intramucosal pH (pHi) during orthotopic liver transplantation (OL T) without venovenous bypasss. Methods Twenty patients (14 males and 6 females) aged (46.7 ±4.6) years, undergoing orthotopic liver transplantation without venovenous byp asss, were included in this study. A gastric tube technique was used to draw gas tric juice 3～5 mL to determine pHi and PiCO 2 before OLT, at 20 min preanhep atic phase, 30 min anhepatic phase, 30 min new hepatic phase and at 2 h and 2 4 h after operation. The arterial blood samples collected taken for the measure ments of PaCO 2, PO 2, pH, BE and HCO 3- at the same time point s as above. pHi was calculated through Henderson-Hasselbach equation. Results The gastric intraumucosal pH (pHi) was decreased significant ly at the time points of 30 min anhepatic phase and 30 min new hepatic phase c ompared with before operation (P< 0.01). And the pHi at the point of 30 min new hepatic phase reached the lowest point. The pHi at the point of 2 h aft er operation was not increased significantly, and also lower than that before op eration (P< 0.05). Conclusion Gastric intraumucosal hypoperfusion and ischemia may take place during OLT especially after blocking t he inferior vena cava. With the time of blocking the inferior vena cava prolonge d gastric intraumucosal hypoperfusion and acidosis become obvious. To apply anti -acid drug trement before operation, to reduce the fluctuation of hemodynamics and to shorten the anhepatic phase do good to patients undergoing orthotopic liv er transplantation. These methods can increase pHi, protect gastric intraumucosa and reduce postoperative complications.
出处
《西安交通大学学报（医学版）》
CAS
CSCD
北大核心
2004年第5期495-497,509,共4页
Journal of Xi’an Jiaotong University（Medical Sciences）
关键词
原位肝移植
胃黏膜PH
胃黏膜PCO2
动脉血气分析
orthotopic liver transplantation
gastricintramu cosal pH
gastric intramucosal PCO 2
arterial blood gas analysis
