摘要
目的 :探讨同种异体肝、小肠联合移植的麻醉处理和生理功能的维护。 方法 :1例患者采用静脉、吸入复合麻醉 ,术中监测有创动脉血压、中心静脉压、心率、心电图、脉搏氧饱和度、呼气末二氧化碳分压、血气、电解质、体温等。 结果 :在游离残余小肠期、移植小肠血管开放期、无肝期、新肝期血流动力学变化很大 ,血压明显降低 ,心率加快 ;凝血酶原时间、部分凝血活酶活化时间、凝血酶时间显著延长 ,凝血因子Ⅰ浓度显著下降 ;血 pH和标准剩余碱 (SBE)呈代谢性酸中毒改变 ,血氯一过性升高 ,血钙偏低 ,无肝期血糖升高 ;体温维持在 36～ 37℃。 结论 :同种异体肝肠联合移植术麻醉的管理和监测非常重要 ,最好采用静脉、吸入复合麻醉 ,选用对肝、肾功能影响小的药物。尤其要做好血流动力学和凝血功能的调控、酸碱和电解质平衡以及体温的维持。
Objective: To explore the anaesthetic management and integral physiological functional regulation during operation in allogeneic combined transplantation of liver and small intestine. Methods:The patient received intravenous and volatile mixed anaesthesia. During operation, invasive arterial pressure, central venous pressure, heart rate, electrocardiogram, pulse oximetry, end-tidal carbon dioxide pressure, blood gas, electrolyte and body temperature were monitored. Results: At the phases of freeing small intestine, vessel opening of novel intestine, anhepatic phase and novel hepatic phase, the blood pressure were significantly decreased; heart rate increased,prothrombin time, partial thromboplastin time and thrombin time obviously prolonged; the concentration of fibrinogen obviously decreased; the patient demonstrated acidosis;blood chlorine and calcium decreased. At the anhepatice phase,blood sugar increased. Body temperature maintained between 36-37℃. Conclusion: Intravenous and volatile mixed anaesthesia is most optimal for allogeneic combined transplantation of liver and small intestine. Drugs with little effect on liver and renal function are preferred. At the same time, it is necessary to maintain circulation stable, correct coagulation function, imbalance of acid-base and serum electrocytes, protect renal function, and maintain normal body temperature.
出处
《医学研究生学报》
CAS
2004年第1期45-48,共4页
Journal of Medical Postgraduates
