原位肝移植围术期混合静脉血氧饱和度改变及临床意义
摘要,目的,方法,结果,结论,关键词,Changeinmixedvenousoxygensaturationinpatientsinperiopera
刘德昭 黑子清 陈信芝 罗晨芳 甘小亮 黎尚荣 罗刚健【摘要】 目的 观察原位肝移植围术期混合静脉血氧饱和度(SvO2)的变化及其临床意义。方法 20例终末期肝硬化患者接受原位肝移植术。采用心排仪持续监测围术期SvO2、氧供(DO2)、氧耗(VO2)、氧摄取率(ERO2)、体温、心排血量(CO)、平均动脉压(MAP)的变化，分析肝移植围术期SvO2与上述各指标的相关性。结果 SvO2在无肝期前15 min较术前增高(P<0.05)，在无肝期30 min较无肝期前15 min显著降低(P<0.05)，在新肝期30 min和术毕较术前均显著增高(P均<0.05)。机体DO2、VO2在无肝期30 min均显著降低(P均<0.05)，而在进入新肝期后均显著增高(P均<0.05)；ERO2进入新肝期后显著增加(P<0.05)。SvO2在各时间点均与VO2有显著相关性(P均<0.05)，而与DO2、血红蛋白无相关性(P均>0.05)；SvO2术前与CO有显著相关性(P<0.05)，其他时间点均无相关性(P均>0.05)。结论 原位肝移植围术期持续监测SvO2对于改善氧代
谢具有重要的临床意义。
【关键词】 肝移植，原位； 混合静脉血氧饱和度； 氧供； 氧耗； 心排血量； 血流动力学； 血氧代谢
Change in mixed venous oxygen saturation in patients in perioperative periods of orthotopic liver transplantation and its clinical implicationLIU De-zhao, HEI Zi-qing, CHEN Xin-zhi, LUO Chen-fang, GAN Xiao-liang, LI Shang-rong, LUO Gang-jian. Department of Anaesthesiology, Third Affiliated Hospital of Sun Yat Sen University, Guangzhou 510630, Guangdong, China
Corresponding author:HEI Zi-qing(Email:heiziqing@sina. com)
OBJECTIVE: To observe the changes in mixed venous oxygen saturation(SvO2)during perioperative periods of orthotopic liver transplantation (OLT), and explore its clinical significances. METHODS: Twenty patients in terminal stage of hepatic cirrhosis were scheduled for OLT under combined general anesthesia. Vigilance monitor (Edwards, USA) was employed to monitor perioperative SvO2, oxygen delivery (DO2), oxygen consumption(VO2), oxygen extraction rate (ERO2) and body temperature, cardiac output (CO),and mean arterial blood pressure (MAP). RESULTS: Compared with the preoperative stage, SvO2 elevated during 15 minutes of anhepatic stage (P<0.05), but decreased significantly during 30 minutes compared to that during 15 minutes of anhepatic stage. Then it was elevated significantly at 30 minutes after the reperfusion of the graft and at the end of operation (all P<0.05). Both DO2 and VO2 were decreased significantly during the anhepatic phase (both P<0.05), and increased significantly after graft reperfusion (all P<0.05)；ERO2 increased significantly after graft reperfusion (P<0.05). The level of SvO2 was correlated with VO2 significantly at each stage (all P<0.05), but not with DO2 and hemoglobin (all P<0.05). SvO2 was correlated well with CO before operation (P<0.05), but not at the other time points (all P>0.05). CONCLUSION: Monitoring SvO2 continually is of clinical significance in patients during OLT. ......
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