Scherer R, Giebler R, Erhard J, Lange R, Günnicker M, Schmutzler M, Paar D, Kox W J
Institute of Anaesthesiology, University Hospital Essen, Germany.
Anaesthesia. 1994 May;49(5):398-402. doi: 10.1111/j.1365-2044.1994.tb03471.x.
Veno-venous bypass is commonly used during orthotopic liver transplantation, but there is some controversy as to whether it contributes to a better outcome. Low shunt flows frequently reduce the efficacy of portofemoro-axillary systems and so a percutaneous cannulation technique for the subclavian and femoral vein with large bore catheters was developed in order to facilitate bypass management. This study reports the performance and complications of a portofemoro-subclavian bypass system during the anhepatic phase of human orthotopic liver transplantation in 85 patients. A percutaneous cannulation technique and two 7 mm (subclavian and femoral) catheters, inserted pre-operatively, were used in a pump driven portofemoro-subclavian bypass system. Coagulation profiles, shunt flows, haemodynamic parameters, and peri-operative complications associated with bypass were recorded for each patient. Percutaneous cannulation of the left femoral and subclavian vein was successful in 78 patients (91.8%). Mean femoro-subclavian shunt flow was 1.45 l.min-1 (SD 0.37), and mean portofemoro-subclavian flow was 4.28 l.min-1 (SD 1.03). Although oxygen delivery was not maintained at pre-shunt levels (559.7 (SD 147) vs 506 (SD 107) ml.min-1.m-2, p < 0.05) renal perfusion pressure stayed above 50 mmHg (during shunt it was 56 (SD 9) mmHg). One intra-operative air embolism was observed (1.2%), and in one patient a myocardial infarction occurred during the anhepatic phase; neither complication was considered to be related to the percutaneous cannulation technique. There were no bleeding complications. After operation, all chest X rays were normal and clinical examination revealed no adverse effects of portofemoro-subclavian bypass.(ABSTRACT TRUNCATED AT 250 WORDS)
静脉 - 静脉转流术在原位肝移植过程中常用，但对于其是否能带来更好的结果存在一些争议。低分流流量常常会降低股静脉 - 腋静脉系统的效能，因此开发了一种使用大口径导管经皮穿刺锁骨下静脉和股静脉的技术，以便于转流管理。本研究报告了85例人体原位肝移植无肝期时股静脉 - 锁骨下静脉转流系统的性能及并发症情况。在一个泵驱动的股静脉 - 锁骨下静脉转流系统中，采用了术前经皮穿刺技术并插入两根7毫米（锁骨下静脉和股静脉）的导管。记录了每位患者的凝血指标、分流流量、血流动力学参数以及与转流相关的围手术期并发症。78例患者（91.8%）经皮穿刺左股静脉和锁骨下静脉成功。股静脉 - 锁骨下静脉平均分流流量为1.45升/分钟（标准差0.37），股静脉 - 锁骨下静脉平均总流量为4.28升/分钟（标准差1.03）。尽管氧输送未维持在转流前水平（559.7（标准差147）对506（标准差107）毫升/分钟·平方米，p<0.05），但肾灌注压保持在50毫米汞柱以上（转流期间为56（标准差9）毫米汞柱）。观察到1例术中空气栓塞（1.2%），1例患者在无肝期发生心肌梗死；两种并发症均被认为与经皮穿刺技术无关。无出血并发症。术后，所有胸部X光片均正常，临床检查未发现股静脉 - 锁骨下静脉转流的不良影响。（摘要截短于250字）
