Manciu N, Beebe D S, Tran P, Gruessner R, Sutherland D E, Belani K G
Department of Anesthesiology, University of Minnesota Medical School, Minneapolis 55455, USA.
J Clin Anesth. 1999 Nov;11(7):576-82. doi: 10.1016/s0952-8180(99)00100-2.
To make recommendations for the perioperative management of patients undergoing total pancreatectomy with islet cell autotransplantation.
Retrospective review.
University hospital.
41 patients undergoing total pancreatectomy with autologous islet cell transplantation for chronic pancreatitis from 1977 to 1996.
The charts and anesthetic records were reviewed, specifically investigating the changes in portal venous pressure, blood pressure (BP), and central venous pressure with islet cell injection. The records also were examined for blood glucose levels, type of fluids administered, blood loss, and postoperative complications.
Injection of islet cells into the portal vein caused a significant increase in portal venous pressures (8.5 +/- 4.8 to 27 +/- 16 cm/H2O; p < 0.001), which remained elevated at the end of injection (23 +/- 12 cm/H2O; p < 0.001). Central venous pressures also increased a small amount (9.3 +/- 4.3 to 10.6 +/- 5.8 mmHg; p < 0.05). In contrast, systolic blood pressures (SBPs) fell with administration of the islet cells (110 +/- 15 to 103 +/- 17 mmHg; p < 0.01), but SBP recovered in most patients at the end of injection (106 +/- 16 mmHg; p = NS). However, 6 patients (14.6%) required vasopressors to maintain adequate BPs. Blood glucose levels were significantly higher immediately prior to islet cell infusion in patients who had received dextrose-containing solutions than those who did not (246 +/- 80 vs. 176 +/- 43 gm/dl; p = 0.002). Median blood loss was 2000 ml (range 350 to 12,000 ml), and most patients (95.1%) required blood transfusions.
Although total pancreatectomy with islet cell autotransplantation is a difficult operation, with significant blood loss, most patients tolerate surgery and injection of islet cells into their portal system without hemodynamic instability. Glucose-containing solutions should not be administered to patients prior to islet cell infusion because hyperglycemia, which can damage islet cells, may result.
为接受全胰切除术并行胰岛细胞自体移植患者的围手术期管理提供建议。
回顾性研究。
大学医院。
1977年至1996年间41例因慢性胰腺炎接受全胰切除术及自体胰岛细胞移植的患者。
查阅病历及麻醉记录，特别调查胰岛细胞注射时门静脉压力、血压（BP）及中心静脉压的变化。还检查记录中的血糖水平、所输液体类型、失血量及术后并发症。
向门静脉注射胰岛细胞导致门静脉压力显著升高（从8.5±4.8升至27±16 cm/H2O；p<0.001），注射结束时仍保持升高（23±12 cm/H2O；p<0.001）。中心静脉压也有少量升高（从9.3±4.3升至10.6±5.8 mmHg；p<0.05）。相比之下，收缩压（SBP）在注射胰岛细胞时下降（从110±15降至103±17 mmHg；p<0.01），但大多数患者在注射结束时SBP恢复（106±16 mmHg；p=无显著性差异）。然而，6例患者（14.6%）需要使用血管升压药来维持足够的血压。接受含葡萄糖溶液的患者在胰岛细胞输注前即刻血糖水平显著高于未接受者（246±80 vs. 176±43 gm/dl；p=0.002）。中位失血量为2000 ml（范围350至12,000 ml），大多数患者（95.1%）需要输血。
尽管全胰切除术并行胰岛细胞自体移植是一项困难的手术，失血量较大，但大多数患者能够耐受手术及向门静脉系统注射胰岛细胞，且无血流动力学不稳定情况。在胰岛细胞输注前不应给患者输注含葡萄糖溶液，因为可能导致高血糖，而高血糖会损害胰岛细胞。
