摘要
【摘要】目的评价左室射血时间指导肝移植术中容量管理的效果。方法拟在全麻下行首次肝移植术患者60例，年龄32～64岁，体重54～93kg，ASA分级Ⅱ或Ⅲ级，肝功能Child—Pugh分级A或B级。采用随机数字表法分为2组（n=30）：对照组（C组）和食管超声监测组（TEE组）。补液原则：c组维持平均有创动脉压、HR和CVP波动幅度不超过基础值的20％，尿量〉1ml·kg-1·h-1.TEE组维持左室射血时间0．35～0．40S。记录术中血管活性药物使用量、输液量、输血量、出血量和尿量。记录围术期不良事件的发生情况、术后拔除气管导管时间和ICU滞留时间。结果与c组比较，TEE组术中多巴胺、去甲肾上腺素使用量减少，尿量增多，围术期心肌缺血、肺水肿和肾功能衰竭发生率降低，术后拔除气管导管时间和ICU滞留时间缩短（P〈O．05）。2组晶体液、胶体液、红细胞、血浆输注量和出血量差异无统计学意义（P〉0．05）。结论左室射血时间指导肝移植术中容营管理的效果较好。
Objective To evaluate the efficacy of left ventricular ejection time （LVET） in guiding the volume management during liver transplantation. Methods Sixty American Society of Anesthesiologists physical status Ⅱ or Ⅲ patients, aged 32-64 yr, weighing 54-93 kg, of Child-Pugh grade A or B liver function, seheduled for elective the first liver transplantation with general anesthesia, were divided into ei- ther control group （group C ） or transesophageal echoeardiography （TEE） monitoring group （group TEE） , with 30 patients in each group. In group C, the fluctuating range of mean arterial pressure, heart rate and central venous pressure was maintained less than 20% of the baseline value, and the urine wdume was maintained 〉1 ml kg i . h-i LVET was maintained between 0.35-0.40 s in group TEE. The con- sumption of intraoperative vasoactive agents （dopamine, norepinephrine, epinephrine）, volume of fluid infused, volume of blood transfused, blood loss and urine volume were recorded. The occurrence of ad- verse events was observed during the perioperative period, and postoperative extubation time and intensive care unit residence time were also reeorded. Results Compared with group C, the consumption of intrao- perative dopamine and norepinephrine was significantly decreased, the urine volume was increased, the in- cidence of myocardial isehemia, pulmonary edema and renal failure in the perioperative period was de- creased, and the postoperative extubation time and intensive care unit residenee time were shortened in group TEE （P〈0.05）. There was no significant difference between the two groups in the volume of crystal- loid, colloid, red blood cells and plasma infused or blood loss （P〉O. 05）. Conclusion LVET produces good efficacy in guiding the volume management during liver transplantation.
出处
《中华麻醉学杂志》
CSCD
北大核心
2017年第6期704-707,共4页
Chinese Journal of Anesthesiology
基金
天津市卫生行业重点攻关项目（13KG105,16KG101）
天津市自然科学基金（17JCYBJc28000）
2014天津医学会麻醉学分会青年科研培育基金项目（TJMZJJ-2014-01）
关键词
每搏输出量
肝移植
容量管理
Stroke volume
Liver transplantation
Volume management
