Xu Zhen-Dong, Xu Hai-Tao, Li Wei-Wei, Zou Zui, Shi Xue-Yin
Department of Anesthesiology, Shanghai First Maternity and Infant Health Hospital, Tongji University School of Medicine 536 Changle Road, Shanghai 200040, P.R. China.
Int J Clin Exp Med. 2013 May 22;6(5):351-7. Print 2013.
Left ventricular diastolic dysfunction is receiving more attention in patients with end-stage liver diseases. The importance of diastolic dysfunction observed before orthotopic liver transplantation (OLT) and its adverse effects on hemodynamics and outcomes of OLT patients, have not been fully explored. We carried a retrospective study to investigate the influence of diastolic dysfunction on OLT patients.
Included in this retrospective study were 330 consecutive patients scheduled for cadaveric OLT over a 5-year period. According to preoperative Doppler echocardiogram (ECHO) findings, patients were divided into two groups: DD group (patients with diastolic dysfunction) and control group (patients with normal ECHO). Patient characteristics, operation variables, hemodynamic course, blood products and drug requirements, postoperative courses and outcomes were evaluated.
306 patients met the study entry criteria and 100 had preoperative diastolic dysfunction. Mean artery blood pressure was significantly lower in DD group after graft reperfusion than that in control group (P<0.01). More patients in DD group required epinephrine, and the mean dose of epinephrine was higher in DD group than that in control group (P<0.01). There was no significant difference in postoperative ventilation time, duration of ICU and hospital stay, renal failure and postoperative mortality between the two groups.
Diastolic dysfunction is common in liver transplant recipients. Patients with diastolic dysfunction may be associated with substantial hemodynamic alterations after graft reperfusion and need more inotropic support during OLT. Diastolic dysfunction was not associated with significant adverse postoperative outcomes.
终末期肝病患者的左心室舒张功能障碍日益受到关注。原位肝移植（OLT）前观察到的舒张功能障碍的重要性及其对OLT患者血流动力学和预后的不良影响尚未得到充分研究。我们进行了一项回顾性研究，以调查舒张功能障碍对OLT患者的影响。
本回顾性研究纳入了5年内连续330例计划接受尸体OLT的患者。根据术前多普勒超声心动图（ECHO）检查结果，将患者分为两组：舒张功能障碍组（DD组，舒张功能障碍患者）和对照组（ECHO正常患者）。评估患者特征、手术变量、血流动力学过程、血液制品和药物需求、术后过程及预后。
306例患者符合研究纳入标准，其中100例术前存在舒张功能障碍。移植肝再灌注后，DD组平均动脉血压显著低于对照组（P<0.01）。DD组更多患者需要肾上腺素，且DD组肾上腺素平均剂量高于对照组（P<0.01）。两组术后通气时间、ICU住院时间、住院时间、肾衰竭及术后死亡率无显著差异。
舒张功能障碍在肝移植受者中常见。舒张功能障碍患者在移植肝再灌注后可能伴有显著的血流动力学改变，OLT期间需要更多的正性肌力支持。舒张功能障碍与术后显著不良预后无关。
