Objective To retrospectively analyze the anesthetic management of infant and young child liver transplanta-tion. Methods Seven pediatric patients (including 1 cases of living donor liver transplantation ) with liver transplantation due to congenital biliary atresia and end-stage liver disease in our hospital from July 21,2013 to May 20,2014 were included in this ret-rospective study. The patients entered into the operation room without venous access. The peripheral vein was opened after intra-muscular injection of ketamine 2-5 mg/kg and atropine 0.02 mg/kg. Anesthesia were rapidly induced by intravenous midazolam 0.05-0.20 mg/kg,propofol 2-3 mg/kg,vecuronium 0.1-0.2 mg/kg and fentanyl 5μg/kg. Then intubation was visually performed through mouth. The anesthetic maintenance adopted 2%-3% sevoflurance inhalation combined with 0.2-0.3 μg/(kg·min) remifentanil and 2-3μg/(kg·min)cis-atracurium by venous pump. The indexes including general situation,operation time,time of anhepatic phase,amount of bleeding,urine volume and intravenous infusion amount were observed;the changes of respiration, circulation,blood gas and coagulation indicators were recorded immediately before occlusion of the portal vein ,immediately after occlusion of the portal vein,20 min during the anhepatic phase,immediately after reperfusion,1 h during the neohepatic phase and end of operation. Results All of the seven patients were successfully extubated without obvious anesthesia related compli-cations. HR immediately after occlusion of the portal vein was significantly increased compared with that immediately before oc clusion,and the difference was statistically significant[(129.00±4.38)bpm/min vs. (114.14±11.65)bpm/min,P<0.05],but MAP and CVP at these two time points had no statistically significant (P>0.05);MAP immediately before occlusion of the portal vein and at 1 h during the neohepatic phase were[(45.14±6.49),(54.57±6.50)mm Hg(1 mm Hg=0.133 kPa),which were significantly de-creased compared with(69.57±5.97)mm Hg before occlusion,the differences were statistically signioficant(P<0.05),but HR and CVP had no statistical differences among these 3 time points(P>0.05);blood sodium level at the end of operation was significantly increased compared with that immediately before occlusion[(139.5±3.51)mmol/L vs.(133.00±6.03)mmol/L],blood glucose levels immediately after reperfusion and at 1 h during the neohepatic phase were (11.21±3.90)mmol/L and(13.91±4.48)mmol/L respec-tively,which were significantly higher than(6.39±2.45)mmol/L immediately before occlusion,the differences were statistically significant(P<0.05);the lactic acid level at 1 h during the neohepatic phase was significantly increased compared with that imme-diately before occlusion[(4.40±1.54)mmol/L vs. 2.50±2.16)mmol/L],blood pH value was significantly decreased(7.32±0.04 vs. 7.40±0.07),the difference was statistically significant(P<0.05). Conclusion Anesthesia in infant and young child liver transplan-tation is more elaborate and special. Respiration ,circulation and internal environment should be closely monitored in order to con-duct timely intervention and actively improve the prognosis of infant and young child liver transplantation.%目的：回顾性分析婴幼儿肝移植术的麻醉管理。方法选取2013年7月21日至2014年5月20日该院收治的先天性胆道闭锁、终末期肝病接受肝移植术患儿7例（包括活体肝移植1例）。患儿入室时均无静脉通路，予以氯胺酮2~5 mg/kg和阿托品0.02 mg/kg肌内注射后开放外周静脉，先后予以咪达唑仑注射液（力月西）0.05~0.20 mg/kg、丙泊酚2~3 mg/kg、维库溴铵0.1~0.2 mg/kg、芬太尼5μg/kg进行静脉快速诱导后经口可视下插管，麻醉维持采用2%~3%七氟烷吸入复合静脉泵注瑞芬太尼0.2~0.3μg/（kg·min）和顺式阿曲库铵2~3μg/（kg·min）。观察患儿一般情况、手术时间、无肝期、出血量、尿量、静脉滴注量，以及阻断前即刻、阻断后即刻、无肝期20 min、再灌注即刻、新肝期1 h和手术结束时的呼吸、循环、血气、凝血指标等变化。结果7例患儿均未出现严重麻醉相关并发症，术后顺利脱机拔管。阻断后即刻心率[（129.00±4.38）次/分]较阻断前即刻明显加快[（114.14±11.65）次/分]，差异有统计学意义（P＜0.05），但2个时刻平均动脉压（MAP）和中心静脉压（CVP）比较，差异无统计学意义（P＞0.05）；再灌注后即刻和新肝期1 h MAP [（45.14±6.49）、（54.57±6.50）mm Hg（1 mm Hg=0.133 kPa）]较阻断前即刻[（69.57±5.97）mm Hg]明显降低，差异均有统计学意义（P＜0.05），但3个时刻心率和CVP比较，差异均无统计学意义（P＞0.05）；手术结束时血钠水平[（139.5±3.51）mmol/L]较阻断前即刻[（133.00±6.03）mmol/L]明显升高，再灌注后即刻和新肝期1 h血糖[分别为（11.21±3.90）、（13.91±4.48）mmol/L]较阻断前即刻[（6.39±2.45）mmol/L]明显升高，差异均有统计学意义（P＜0.05）；新肝期1 h 乳酸[（4.40±1.54）mmol/L]较阻断前即刻[（2.50±2.16）mmol/L]明显升高，血pH值（7.32±0.04）较阻断前即刻（7.40±0.07）明显降低，差异均有统计学意义（P＜0.05）。结论婴幼儿肝移植术的麻醉更为精细和特殊，呼吸、循环及内环境应严密监测、及时干预，积极改善婴幼儿肝移植预后。
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