Jugan E, Albaladejo P, Jayais P, Ecoffey C
Department of Anesthesiology, Paul Brousse Hospital, Université Paris-Sud, Villejuif, France.
Transplantation. 1992 Jul;54(1):81-4. doi: 10.1097/00007890-199207000-00014.
We studied 58 patients undergoing orthotopic liver transplantation, aged 42 +/- 10 years (mean +/- SD), and weighing 65 +/- 14 kg. Anesthesia was maintained with fentanyl, midazolam, and vecuronium. Serum bicarbonate, serum potassium, serum ionized calcium and pH did not change significantly throughout the study. Usual hemodynamic parameters were recorded. Hemodynamic tolerance was assessed by a trial of clamping of the inferior vena cava, above and below the liver and the portal vein; patients were allocated to two groups: the group without venovenous bypass (NBP, n = 29) consisted of patients whose MAP did not decrease by more than 30% and/or cardiac output did not decrease by more than 50%; the group with venovenous bypass (BP, n = 29) consisted of patients whose MAP decreased by more than 30% and/or cardiac output decreased by more than 50% or required venovenous bypass for easier surgical dissection. After clamping of the vena cava and the portal vein, the cardiac index (CI) and mean pulmonary arterial pressure (MPAP) decreased significantly, whereas systemic vascular resistances (SVR) increased. After unclamping the inferior vena cava suprahepatically and infrahepatically, no hemodynamic change was observed. After unclamping the portal vein, MAP decreased, despite the increase in the CI, because of an significant decrease in SVR; in addition MPAP increased despite the decrease in pulmonary vascular resistances. The decrease in MAP of more than 30% during at least 1 min occurred in 6 patients (20%) in the NBP group and in 6 patients (20%) in the BP group. We concluded that the occurrence of the syndrome of cardiovascular collapse following liver reperfusion was similar whether venovenous bypass was used or not.
我们研究了58例接受原位肝移植的患者，年龄为42±10岁（均值±标准差），体重为65±14千克。麻醉维持采用芬太尼、咪达唑仑和维库溴铵。在整个研究过程中，血清碳酸氢盐、血清钾、血清离子钙和pH值均无显著变化。记录了常规血流动力学参数。通过在肝脏上下方及门静脉处夹闭下腔静脉的试验来评估血流动力学耐受性；患者被分为两组：无静脉-静脉转流组（NBP，n = 29），包括平均动脉压（MAP）下降不超过30%和/或心输出量下降不超过50%的患者；静脉-静脉转流组（BP，n = 29），包括MAP下降超过30%和/或心输出量下降超过50%或为便于手术解剖而需要静脉-静脉转流的患者。夹闭下腔静脉和门静脉后，心脏指数（CI）和平均肺动脉压（MPAP）显著下降，而全身血管阻力（SVR）增加。在肝上下方和肝下方松开下腔静脉夹后，未观察到血流动力学变化。松开门静脉夹后，尽管CI增加，但由于SVR显著下降，MAP仍下降；此外，尽管肺血管阻力下降，但MPAP仍增加。NBP组有6例患者（20%）、BP组有6例患者（20%）在至少1分钟内MAP下降超过30%。我们得出结论，无论是否使用静脉-静脉转流，肝再灌注后心血管崩溃综合征的发生率相似。
