CAJ | 학술논문

目的探讨非静脉转流经典原位猪肝移植术的麻醉期管理.方法将38头猪随机分为两组,分别为供体组和受体组,对实验猪行经口气管内插管+静脉复合麻醉,施行同种异体原位肝移植术.观察其各时相血流动力学、血气、血生化及肝功能的改变.结果 38头猪中35头成功施行气管插管,3头行气管切开.实验猪对麻醉药有较大的耐受量,无肝期麻醉药用量明显减少;无肝期和新肝期血流动力学变化剧烈并伴有代谢性酸中毒,血清K+在新肝期有一过性升高.在肝移植麻醉及手术过程中,平均动脉压(mean arterial pressure,MAP)、中心静脉压(central venous pressure,CVP)、心率(heart rate,HR)、碱剩余(bases excess,BE)、动脉血二氧化碳分压(PaCO:)等均有较大的波动,其中,在无肝期至新肝期后0.5 h变化最剧烈.结论对实验猪实施经口气管内插管可行;无肝期不需要深麻醉状态;血流动力学改变的处理应以预防为主,随时纠正酸碱平衡紊乱.合理应对无肝期至新肝期后0.5 h期间的循环系统和机体内环境的剧烈变化是麻醉是否成功的关键.
목적 탐토비정맥전류경전원위저간이식술적마취기관리.방법 장38두저수궤분위량조,분별위공체조화수체조,대실험저행경구기관내삽관+정맥복합마취,시행동충이체원위간이식술.관찰기각시상혈류동역학、혈기、혈생화급간공능적개변.결과 38두저중35두성공시행기관삽관,3두행기관절개.실험저대마취약유교대적내수량,무간기마취약용량명현감소;무간기화신간기혈류동역학변화극렬병반유대사성산중독,혈청K+재신간기유일과성승고.재간이식마취급수술과정중,평균동맥압(mean arterial pressure,MAP)、중심정맥압(central venous pressure,CVP)、심솔(heart rate,HR)、감잉여(bases excess,BE)、동맥혈이양화탄분압(PaCO:)등균유교대적파동,기중,재무간기지신간기후0.5 h변화최극렬.결론 대실험저실시경구기관내삽관가행;무간기불수요심마취상태;혈류동역학개변적처리응이예방위주,수시규정산감평형문란.합리응대무간기지신간기후0.5 h기간적순배계통화궤체내배경적극렬변화시마취시부성공적관건.
Objective To investigate anesthesia management for orthotopic liver transplantation (OLT) in pigs without anhepatic veno-venous bypass. Methods 38 healthy pigs were divided into two groups at random:19 donators, 19 receivers. The oral intubation and total intravenous anesthesia were adopted in all pigs. The hemodynamic changes were continuously monitored during the operating phases. The changes of arterial blood gas, blood biochemistry and liver functions were monitored during preanhepatic phase, anhepatic phase and neohepatie phase in 19 receivers. Results The oral intubation was successful in 35 cases, and tracheotomy in 3 cases. The pigs had much tolerance to narcotic, and the volume of narcotic was decreased obviously in anhepatic phase. There were remarkable hemodynamic changes and severe metabolic acidosis during anhepatie phase and neohepatie phase compared with the preanhepatic phase, and temporary serum kalium concentration increased during primary neohepatic phase. The apparent fluctuation of mean arterial blood pressure (MAP), central venous pressure (CVP), heart rate (HR), bases excess (BE), and arterial partial pressure of carbon dioxide ( PaCO2 ) were observed during the period of liver transplantation. Conclusion The oral intubation can be adopted in pigs.Anesthesia can be lighter during the anhepatic phase. Hemodynamics and acid base and electrolyte equilibrium change significantly.Therefore it is very important to monitor hemodynamies and blood biochemistry and arterial blood gas in order to prevent and manage their disturbance during anhepatic to neohepatic phase in orthotopic liver transplantation.