Sanabria Carretero P, Herranz Ortega M A, Rodríguez Pérez E, Goldman Tarlousky L, Martín Barrera G, López Santamaría M
Servicio de Anestesia-Reanimación Pediátrica, Hospital Infantil Universitario, "La Paz", Madrid.
Rev Esp Anestesiol Reanim. 2004 Feb;51(2):95-9.
A 15-year-old female with short intestine syndrome due to chronic intestinal pseudo-obstruction associated with kidney failure underwent a multivisceral (stomach-duodenum-jejunum-ileum-pancreas-liver) and kidney transplant. She had required parenteral nutrition for the last 5 years, with numerous complications such as sepsis from the central catheter, deep venous thrombosis, severe liver dysfunction, pancytopenia due to bone marrow failure, and severe malnutrition. Surgery lasted 15 hours and was free of complications other than hypothermia, which worsened after revascularization of the grafts. Replacement of 6 units of blood products and crystalloids was required. Biochemical and hemodynamic variables were stable, apart from the development of hypernatremia, hyperglycemia, and lactic acidosis. The anesthetic approach included preoperative assessment of problems related to chronic parenteral nutrition (liver dysfunction, coagulopathy, and restricted venous access), the prevention of hypothermia, correction of electrolyte imbalance and the acid-base status, treatment of reperfusion syndrome, and the replacement of fluids and blood products to maintain circulatory homeostasis and assure sufficient splanchnic perfusion.
一名15岁女性因慢性肠假性梗阻合并肾衰竭导致短肠综合征，接受了多脏器（胃 - 十二指肠 - 空肠 - 回肠 - 胰腺 - 肝脏）及肾脏移植。在过去5年里，她一直需要肠外营养支持，出现了诸多并发症，如中心静脉导管相关脓毒症、深静脉血栓形成、严重肝功能障碍、骨髓衰竭导致的全血细胞减少以及严重营养不良。手术持续了15个小时，除了低温外未出现其他并发症，低温在移植血管再通后加重。需要输注6单位血液制品和晶体液。除了出现高钠血症、高血糖和乳酸性酸中毒外，生化及血流动力学指标保持稳定。麻醉方案包括术前评估与慢性肠外营养相关的问题（肝功能障碍、凝血功能障碍和静脉通路受限）、预防低温、纠正电解质失衡及酸碱状态、治疗再灌注综合征，以及补充液体和血液制品以维持循环稳态并确保足够的内脏灌注。
