肝血管控制下肝切除术的麻醉注意事项。
Anesthetic Considerations in Hepatectomies under Hepatic Vascular Control.
作者信息
Tympa Aliki, Theodoraki Kassiani, Tsaroucha Athanassia, Arkadopoulos Nikolaos, Vassiliou Ioannis, Smyrniotis Vassilios
机构信息
First Department of Anesthesiology, School of Medicine, University of Athens, Aretaieion Hospital, 76 Vassilisis Sofias Avenue, 11528 Athens, Greece.
出版信息
HPB Surg. 2012;2012:720754. doi: 10.1155/2012/720754. Epub 2012 May 28.
Background. Hazards of liver surgery have been attenuated by the evolution in methods of hepatic vascular control and the anesthetic management. In this paper, the anesthetic considerations during hepatic vascular occlusion techniques were reviewed. Methods. A Medline literature search using the terms "anesthetic," "anesthesia," "liver," "hepatectomy," "inflow," "outflow occlusion," "Pringle," "hemodynamic," "air embolism," "blood loss," "transfusion," "ischemia-reperfusion," "preconditioning," was performed. Results. Task-orientated anesthetic management, according to the performed method of hepatic vascular occlusion, ameliorates the surgical outcome and improves the morbidity and mortality rates, following liver surgery. Conclusions. Hepatic vascular occlusion techniques share common anesthetic considerations in terms of preoperative assessment, monitoring, induction, and maintenance of anesthesia. On the other hand, the hemodynamic management, the prevention of vascular air embolism, blood transfusion, and liver injury are plausible when the anesthetic plan is scheduled according to the method of hepatic vascular occlusion performed.
背景。肝脏手术的风险已因肝血管控制方法和麻醉管理的发展而降低。本文对肝血管阻断技术期间的麻醉注意事项进行了综述。方法。使用“麻醉”“麻醉学”“肝脏”“肝切除术”“流入”“流出阻断”“普林格尔法”“血流动力学”“空气栓塞”“失血”“输血”“缺血再灌注”“预处理”等术语进行了医学文献检索。结果。根据所实施的肝血管阻断方法进行以任务为导向的麻醉管理，可改善肝脏手术后的手术效果并提高发病率和死亡率。结论。肝血管阻断技术在术前评估、监测、麻醉诱导和维持方面有共同的麻醉注意事项。另一方面，当根据所实施的肝血管阻断方法制定麻醉计划时，血流动力学管理、血管空气栓塞的预防、输血和肝损伤是可行的。
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