摘要
目的研究肝移植术后患者并发急性肺损伤（ALI）与术中氧代谢的关系。方法择期行肝移植术的终末期肝病患者62例，年龄29～63岁，体重48～76kg，ASA Ⅲ或Ⅳ级。于麻醉诱导后（T1）、无肝期前10min（T2）、无肝期25min（T3）、新肝期30min（T4）及术毕（T3）时，采集桡动脉血和混合静脉血进行血气分析，计算动脉血氧含量（CaO2）、混合静脉血氧含量（CvO2）、动脉-混合静脉血氧含量差（Ca—vO2）、氧供指数（DO2I）、氧耗指数（VO2I）、氧摄取率（ERO2）和通气-血流灌注指数（VQI）。根据术后14d内是否发生ALI分为2组：ALI组和非Au组。两组氧代谢指标与术后ALI发生与否进行logistic回归分析。结果与T1时相比，T2，4，5时PvO2升高，T3时降低，T2-5时CaO2、CvO2升高，T3时Ca—vO2升高，T2，4，5时DO2I、VO2I升高，ERO2降低，T3时VQI降低，氧合指数T3时降低，T4时升高（P〈0．05）。与非ALI组相比，ALI组T4，5时CaO2、CvO2和D02I降低，T1，2，4，5时PaO2降低（P〈0．05）。logistic回归分析结果示T4时PaO2和T5时CaO2与术后发生ALI有关（P〈0．05）。结论肝移植术后患者并发Au可能与新肝期氧代谢异常有关。
Objective To investigate the relationship between the oxygen metabolism during operation and the development of acute lung injury （ALI） after orthotopic liver transplantation （OLT）. Methods Sixty-two ASA m or patients of beth sexes （54 male, g female ） aged 29-63 yr weighing 48-76 kg undergoing OLT were studied. The patients were premedicated with intramuscular phenobarbital 0.1 g and atropine 0.5 mg. Anesthesia was induced with midazolam 0.1 mg/kg, fentanyl 2-4 μg/kg, propefol 1.0-1.5 mg/kg and vecuronium 0.1 mg/kg and maintained with 1%-2% sevoflurane and intermittent iv boluses of fentanyl and vecuronium. The patients were intubated and mechanically ventilated. PET CO2 was maintained at 35-45 mm Hg. Radial artery was cannulated and Swan-Ganz catheter was placed via right IJV into the pulmonary artery. Arterial and mixed venous blood samples were obtained after induction of anesthesia （T1） at 10 min before and 25 min after the beginning of anhepatic phase （T2, T3 ）, 30 rain after beginning of reperfusion of the allograft （T4） and at the end of operation （T5） for blood gas analysis. Arterial O2, content （CaO2） mixed venous O2 content （CvO2）, arterial-mixed venous O2 content difference （ CvO2 ）, oxygen delivery index（ DO2 I）, oxygen consumption index （ VO2 I）, O2 extraction rate （ ERO2 ） and ventilation-perfusion index （VQI） were calculated. The patients were observed for 14 days after operation for postoperative acute lung injury （ALI） which was defined as： PaO2/FiO2 ranges between 200-300, X-ray examination shows infiltration in the bilateral lungs and pulmonary wedge prossure ≤ 18 mm Hg. Results Twentyone patients developed ALI after operation. CaO2, , CvO2, and DO2 at T4.5 and PaO2 at T1,2,4,5 were significantly lower in the patients who developed ALI operation than in those who did not. Logistic analysis showed that PaO2 at T4 and CaOz at T5 were related to the development of ALI after OLT. Conclusion Dysfunction of oxygen metabolism during neo
出处
《中华麻醉学杂志》
CAS
CSCD
北大核心
2008年第12期1085-1088,共4页
Chinese Journal of Anesthesiology
基金
广东省科技计划项目（2004835001005）
广东省自然科学基金资助项目（07001567）
关键词
呼吸窘迫综合征
成人
氧耗量
肝移植
手术后并发症
Respiratory distress syndrome, adult
Oxygen consumption
Liver transplantation
Postoperative complications
