摘要
目的探讨合并卵圆孔未闭的先天性胆道闭锁患儿行原位肝移植围术期血流动力学及心功能的变化。方法回顾性分析2017年2月~2019年2月我院择期行原位肝移植术的先天性胆道闭锁患儿69例,根据心脏多普勒彩超检查结果分为卵圆孔未闭组(P组,卵圆孔>3 mm)27例和非卵圆孔未闭组(N组,卵圆孔≤3 mm)42例,比较两组诱导插管后(T1),门静脉阻断即刻(T2),无肝期10 min(T3),门静脉开放即刻(T4),新肝期1 h(T5),术毕(T6)时HR、MAP、CVP、SV、CO、CI、dp/dt和CCE及不良心血管事件发生率。结果两组T4时点MAP和CI低于T1时点,差异有统计学意义(P<0.05);两组T2、T4时点SV和CO低于T1时点,T6时点SV和CO高于T1时点,差异有统计学意义(P<0.05);两组T2~T6时点CCE低于T1时点,差异有统计学意义(P<0.05);两组各时间点均未发生严重不良心血管事件。结论与非卵圆孔未闭患儿比较,合并卵圆孔未闭的先天性胆道闭锁患儿行原位肝移植围术期血流动力学及心功能变化无差异,术前无明显临床症状或右向左分流致心功能不全,无需对卵圆孔未闭进行手术治疗。
Objective To investigate the perioperative hemodynamics and cardiac function of orthotopic liver transplantation in children with congenital biliary atresia with patent foramen ovale.Methods A retrospective analysis of 69 children with congenital biliary atresia who underwent elective orthotopic liver transplantation in our hospital from February 2017 to February 2019 was performed,According to the Doppler color Doppler ultrasound examination results,the patients were divided into the foramen ovale group(P group,oval foramen>3 mm),27 cases,non-ovate foramen group(N group,oval foramen≤3 mm)42 cases,after induction of intubation(T1),portal vein blockade(T2),no hepatic phase 10 min(T3),portal vein open immediately(T4),new liver phase 1 h(T5),and surgery(T6)HR,MAP,CVP,SV,CO,CI,dp/dt,and CCE and incidence of adverse cardiovascular events.Results At the time of T4,the MAP and CI of the two groups were lower than the time of T1,the difference was statistically significant(P<0.05);the SV and CO at T2 and T4 were lower than T1,and the SV and CO were higher than T1 at T6,the difference was statistically significant(P<0.05).There was a statistically significant difference between the two groups at the time of T2~T6 when the CCE was lower than T1(P<0.05).There were no serious adverse cardiovascular events at each time point.Conclusion Compared with non-ovate patients with patent foramen ovale,there is no difference in perioperative hemodynamics and cardiac function between children with congenital biliary atresia with patent foramen ovale.There is no obvious clinical symptoms before operation.Or right to left shunt to achieve cardiac insufficiency,no need for surgical treatment of patent foramen ovale.
作者
芦树军
刘云霞
喻文立
翁亦齐
王清平
贾莉莉
LU Shu-jun;LIU Yun-xia;YU Wen-li;WENG Yi-qi;WANG Qing-ping;JIA Li-li(Department of Anesthesiology,Tianjin First Central Hospital,Tianjin 300192,China)
出处
《医学信息》
2019年第20期95-97,共3页
Journal of Medical Information
关键词
小儿肝移植
卵圆孔未闭
血流动力学
心功能
Pediatric liver transplantation
Patent foramen ovale
Hemodynamics
Cardiac function
