Zhang Li-ping, Li Min, Yang Lu
Department of Anaesthesia, Peking University Third Hospital, Beijing 100083, China.
Chin Med J (Engl). 2005 Dec 5;118(23):1952-8.
The hyperdynamic circulatory state in end-stage liver disease is similar to the hemodynamic state in endotoxic shock. Recent research indicated that proper use of norepinephrine (NE) in patients with endotoxic shock could improve the perfusion of visceral organs and raise the survival rate. In this study, dopamine (DA) or NE combined with DA was infused during the orthotopic liver transplantation (OLT) to observe and compare their effects on hemodynamics, oxygenation, and renal function during different stages of the operation.
Thirty American Society of Anesthesiology (ASA) III-IV patients undergoing OLT were randomly divided into group DA and group NE with 15 patients in each group. Vasopressors were infused after induction of anesthesia. DA was infused in group DA; DA and NE in group NE. Data of hemodynamics, oxygenation and renal function were collected after induction, 1 hour in preanhepatic, anhepatic, neohepatic phase and at the end of operation.
Heart rate (HR) and mean arterial pressure (MAP) of the two groups were stable. In anhepatic phase, central venous pressure (CVP), mean pulmonary arterial pressure (MPAP), pulmonary arterial wedge pressure (PAWP), cardiac output (CO), and cardiac index (CI) decreased, whereas systemic vascular resistance (SVR) and systemic vascular resistance index (SVRI) increased significantly (P < 0.05). The hemodynamic variables of group NE were more stable than that of group DA. Pulmonary vascular resistance (PVR), pulmonary vascular resistance index (PVRI), power of hydrogen (pH), and mixed venous oxygen saturation (SvO2) had no significant changes. Oxygen delivery (DO2) and oxygen consumption (VO2) decreased during anhepatic phase (P < 0.05), but lactic acid (LAC) increased since anhepatic phase. Blood urea nitrogen (BUN) maintained relatively stable during different phases. Group NE had more urine output (F = 4.733, P = 0.039).
During OLT, both DA and NE combined with DA can maintain hemodynamics stable, whereas the latter may create better condition. NE has positive effects on maintenance of renal function.
终末期肝病的高动力循环状态类似于内毒素休克的血流动力学状态。近期研究表明，在内毒素休克患者中合理使用去甲肾上腺素（NE）可改善内脏器官灌注并提高生存率。在本研究中，原位肝移植（OLT）期间输注多巴胺（DA）或NE联合DA，以观察和比较它们在手术不同阶段对血流动力学、氧合和肾功能的影响。
30例美国麻醉医师协会（ASA）Ⅲ-Ⅳ级行OLT的患者被随机分为DA组和NE组，每组15例。麻醉诱导后输注血管升压药。DA组输注DA；NE组输注DA和NE。在诱导后、无肝前期1小时、无肝期、新肝期及手术结束时收集血流动力学、氧合和肾功能数据。
两组心率（HR）和平均动脉压（MAP）均稳定。在无肝期，中心静脉压（CVP）、平均肺动脉压（MPAP）、肺动脉楔压（PAWP）、心输出量（CO）和心脏指数（CI）下降，而全身血管阻力（SVR）和全身血管阻力指数（SVRI）显著升高（P<0.05）。NE组的血流动力学变量比DA组更稳定。肺血管阻力（PVR）、肺血管阻力指数（PVRI）、氢离子浓度（pH）和混合静脉血氧饱和度（SvO2）无显著变化。无肝期氧输送（DO2）和氧消耗（VO2）下降（P<0.05），但自无肝期起乳酸（LAC）升高。不同阶段血尿素氮（BUN）保持相对稳定。NE组尿量更多（F=4.733，P=0.0３9）。
OLT期间，DA和NE联合DA均可维持血流动力学稳定，而后者可能创造更好的条件。NE对维持肾功能有积极作用。
