Hirata S, Seo N, Murayama T, Fujiwara T
Department of Anesthesiology, Omiya Medical Center, Jichi Medical School.
Masui. 1995 Jul;44(7):1025-8.
We report the usefulness of monitoring hepatic venous saturation (ShVO2) during open heart surgery for a patient with severe liver dysfunction. The patient was a 55-year-old man who had been suffering from acute aortic regurgitation due to bacterial endocarditis. Indocyanine green retention test at 15 min was 55%. Serum GOT, GPT and T bilirubin were 56 U.l-1, 35 U.l-1 and 1.5 mg.dl-1 respectively. Aortic valve replacement was scheduled in spite of severe liver dysfunction because amelioration of congestive heart failure after the operation was expected to improve liver dysfunction to the previous chronic state. Anesthesia was induced and maintained by intermittent administration of diazepam and low dose of fentanyl with 100% oxygen. After induction, we inserted a balloon tipped pulmonary catheter with ultra-red beam into hepatic vein by fluoroscopy guidance and monitored ShVO2 as an index of hepatic oxygen supply/demand balance. During re-insertion of a thoracic catheter, we could detect the continued decrease in hepatic vein saturation even after the improvement of systemic circulatory state. Postoperatively, liver function became slightly worse for a short period and improved thereafter. These results suggest that ShVO2 monitoring is clinically useful in detecting hepatic oxygen supply/demand imbalance which circulatory monitoring could not uncover during open heart surgery.
我们报告了在心脏直视手术期间监测肝静脉血氧饱和度（ShVO2）对一名严重肝功能不全患者的实用性。该患者为一名55岁男性，因细菌性心内膜炎患有急性主动脉瓣关闭不全。15分钟吲哚菁绿滞留试验结果为55%。血清谷草转氨酶、谷丙转氨酶和总胆红素分别为56U.l-1、35U.l-1和1.5mg.dl-1。尽管存在严重肝功能不全，但仍计划进行主动脉瓣置换术，因为预计术后充血性心力衰竭的改善将使肝功能恢复到之前的慢性状态。通过间歇性静脉注射地西泮和低剂量芬太尼并吸入100%氧气诱导并维持麻醉。诱导后，我们在荧光透视引导下将带有红外光束的球囊漂浮肺动脉导管插入肝静脉，并监测ShVO2作为肝氧供需平衡的指标。在重新插入胸导管期间，即使全身循环状态改善后，我们仍能检测到肝静脉血氧饱和度持续下降。术后，肝功能在短时间内略有恶化，随后有所改善。这些结果表明，在心脏直视手术期间，ShVO2监测在检测循环监测无法发现的肝氧供需失衡方面具有临床实用性。
