Tominaga Maiko, Furutani Hidekatsu, Segawa Hajime, Shoda Takehiro, Mima Hiroyuki, Adachi Takehiko, Fukuda Kazuhiko
Department of Anesthesia, Division of Critical Care Medicine, Kyoto University Hospital, Kyoto 606-8507.
Masui. 2003 Jul;52(7):729-32.
Liver transplantation for patients with severe portopulmonary hypertension (PPHTN) has been associated with high mortality. We conducted perioperative management of two patients with severe PPHTN for living-donor liver transplantation. The first case was a 17-year-old male with biliary atresia. He developed dyspnea at the age of 14, for which he was treated with intravenous epoprostenol for 8 months. As a result, the mean pulmonary artery pressure (MPAP) was reduced from 61 to 40 mmHg. Intraoperatively, he was treated with intravenous epoprostenol and nitric oxide (NO) inhalation. His intraoperative course was uneventful but he died from right heart failure on postoperative day (POD) 11. The second case was a 6-year-old girl with biliary atresia. When she was 5 years old, examination for a persistent cough revealed MPAP of 49 mmHg. Neither intravenous epoprostenol nor NO inhalation was effective, and she twice showed transient pulmonary hypertension during the operation. She was extubated 14 hours after the surgery, transferred out of ICU on POD 3 and discharged from the hospital on POD 99. When we compare the two cases, the factors responsible for the success of the management of the second case appear to be early extubation and the short duration of PPHTN.
对于患有严重门肺高压（PPHTN）的患者，肝移植一直与高死亡率相关。我们对两名患有严重PPHTN的患者进行了活体肝移植的围手术期管理。第一例是一名17岁患有胆道闭锁的男性。他在14岁时出现呼吸困难，为此接受了8个月的静脉注射依前列醇治疗。结果，平均肺动脉压（MPAP）从61 mmHg降至40 mmHg。术中，他接受了静脉注射依前列醇和一氧化氮（NO）吸入治疗。他的术中过程顺利，但在术后第11天死于右心衰竭。第二例是一名6岁患有胆道闭锁的女孩。她5岁时，因持续咳嗽检查发现MPAP为49 mmHg。静脉注射依前列醇和NO吸入均无效，且她在手术期间两次出现短暂性肺动脉高压。术后14小时她拔除气管插管，术后第3天转出重症监护病房，并于术后第99天出院。当我们比较这两个病例时，第二例管理成功的因素似乎是早期拔管和PPHTN持续时间短。
