Essandoh Michael, Otey Andrew Joseph, Dalia Adam, Dewhirst Elisabeth, Springer Andrew, Henry Mitchell
Department of Anesthesiology, The Ohio State University Wexner Medical Center , Columbus, OH , USA.
Department of Surgery, The Ohio State University Wexner Medical Center , Columbus, OH , USA.
Front Med (Lausanne). 2016 Feb 16;3:3. doi: 10.3389/fmed.2016.00003. eCollection 2016.
Hypotension after reperfusion is a common occurrence during liver transplantation following the systemic release of cold, hyperkalemic, and acidic contents of the liver allograft. Moreover, the release of vasoactive metabolites such as inflammatory cytokines and free radicals from the liver and mesentery, compounded by the hepatic uptake of blood, may also cause a decrement in systemic perfusion pressures. Thus, the postreperfusion syndrome (PRS) can materialize if hypotension and fibrinolysis occur concomitantly within 5 min of reperfusion. Treatment of the PRS may require the administration of inotropes, vasopressors, and intravenous fluids to maintain hemodynamic stability. However, the occurrence of the PRS and its treatment with inotropes and calcium chloride may lead to dynamic left ventricular outflow tract obstruction (DLVOTO) precipitating refractory hypotension. Expedient diagnosis of DLVOTO with transesophageal echocardiography is extremely vital in order to avoid potential cardiovascular collapse during this critical period.
再灌注后低血压是肝移植过程中的常见现象，这是由于同种异体肝移植的冷、高钾和酸性内容物全身释放所致。此外，肝脏和肠系膜释放血管活性代谢产物，如炎性细胞因子和自由基，再加上肝脏对血液的摄取，也可能导致全身灌注压力下降。因此，如果在再灌注后5分钟内同时出现低血压和纤维蛋白溶解，就会出现再灌注综合征（PRS）。治疗PRS可能需要使用正性肌力药物、血管升压药和静脉输液来维持血流动力学稳定。然而，PRS的发生及其用正性肌力药物和氯化钙治疗可能导致动态左心室流出道梗阻（DLVOTO），进而引发难治性低血压。在这个关键时期，通过经食管超声心动图快速诊断DLVOTO对于避免潜在的心血管崩溃至关重要。
