Scherer R U, Giebler R M, Schmutzler M J, Günnicker F M, Kox W J
Department of Anaesthesiology, University Hospital Essen, Germany.
Br J Anaesth. 1993 Jun;70(6):689-90. doi: 10.1093/bja/70.6.689.
The routine use of veno-venous bypass during the anhepatic phase of orthotopic liver transplantation is controversial. Decreased shunt flows (1.5-3.0 litre min-1), as reported in the literature, may explain the lack of beneficial effects on outcome. We have studied the influence of bypass flows on caval pressure gradient (CPG) and renal perfusion pressure (RPP) in 45 patients undergoing orthotopic liver transplantation using a portofemoro-subclavian veno-venous bypass system. Mean shunt flow was 3.63 litre min-1. Second-order polynomial regressions best described the relationship between shunt flow and CPG (r = 0.674), RPP (r = 0.727), and cardiac output (r = 0.602). Shunt flows less than 3.0 litre min-1 failed to normalize CPG and RPP, whereas flows greater than 5.0 litre min-1 did not substantially improve haemodynamic state.
在原位肝移植的无肝期常规使用静脉-静脉转流存在争议。如文献报道，转流流量降低（1.5 - 3.0升/分钟）可能解释了其对预后缺乏有益影响的原因。我们使用股静脉-锁骨下静脉静脉-静脉转流系统，研究了45例接受原位肝移植患者中转流流量对腔静脉压力梯度（CPG）和肾灌注压（RPP）的影响。平均转流流量为3.63升/分钟。二次多项式回归最能描述转流流量与CPG（r = 0.674）、RPP（r = 0.727）和心输出量（r = 0.602）之间的关系。转流流量低于3.0升/分钟未能使CPG和RPP恢复正常，而流量大于5.0升/分钟并未显著改善血流动力学状态。
