2种保温方法对经典非转流原位肝移植术中患者循环及电解质变化的影响

摘要

目的：探讨2种保温方法对经典非转流原位肝移植术中患者循环和电解质变化的影响。方法34例晚期重症肝病患者（ASA Ⅲ～Ⅳ级），随机分为 H 组（肢体保温＋大范围恒量毯组）和 Q 组（肢体保温＋气热被组），两组患者均行经典非转流原位肝移植术，采用气管内插管全身麻醉。分别于麻醉诱导前与后、无肝期前、无肝期后5 min、无肝期后30 min、再灌注期5 min、再灌注期30 min、术毕即刻8个时点抽取动脉血行动脉血气分析，测定钠、钾、钙离子浓度，监测温度变化。结果两组患者一般情况、手术时间、术中芬太尼用量、无肝期时间、总入量及总出量差异均无统计学意义。两组患者无肝期后30 min、再灌注期5 min、再灌注期30 min 时心率和收缩压比较差异有统计学意义（P ＜0．05）。两组患者在整个围手术期间中心静脉压比较差异均无统计学意义（P ＞0．05）。两组患者在无肝期后30 min、再灌注期5 min、再灌注期30 min 时的体温和 pH 的变化比较差异有统计学意义（P ＜0．05）。两组患者在8个时点的 K＋、Na＋、Ca2＋变化差异无统计学意义（P ＞0．05）。结论在体温得以很好保护的基础上，运用气垫被患者的血流动力学变化更小，机体代谢正常，不会出现严重的酸碱平衡紊乱。肢体保温＋气热被保温更有利于围术期病人生命体征的稳定，更有利于手术成功和术后恢复。%Objective To explore the effects of circulation and electrolytic on patients during classic unturn-flowing orthotopic liver transplantation.Methods ASA Ⅲ or Ⅴ grade thirty-four patients undergone or-thotopic liver transplantation,Age from 26-72,weight from 49-82 kg ,were divided randomly into two groups.H group is body heat preservation and large constant carpet group,Q group is body heat preserva-tion and gas-hot preservation.Two groups were performed classic unturn-flowing during orthotopic liver transplantation.All patients with endotracheal intubation anesthesia.Blood samples were taken from artery for blood-gas analysis at before and after anesthesia induction,Anhepatic phase before and after 5 min and 30 min,reperfusion period 5min and 30 min,at the end of the surgery.Determinate the concen-tration of sodium,potassium,calcium,at the same time monitored the temperature change.Results The results showed that the general situation,the operation time,the fentanyl dosage in operatine,Anhepatic phase,the total amount and total quantity were no significant between two groups,there were no signifi-cant at before and after anesthesia induction,the change of hemodynamic before and after Anhepatic phase 5 min,between two groups.After anhepatic phase 30 min,after reperfusion 5 min,30 min had significant difference in HR and SBP.There was no significantat difference during the perioperative period between two groups.With the extension of operation time,the change of temperature and pH in the absence of af-ter anhepatic phase 30 min,5 min and 30 min period of reperfusion,were statistically significant.There were no statistically significant difference at the change of sodium,potassium,calcium in eight points. Conclusion On the basis of the temperature was protected well,the hemodynamic changes smaller,al-though the body′s metabolism is normal,there was noserious acid-base balance disorders existed.Body heat preservation and gas-hot preservation was more advantageous to stable vital signs in perioperative, and more conducive to the success of the operation and postoperative recovery.