CAJ | 학술논문

目的通过脉搏指示剂连续心输出量(PiCCO)监护仪对肝移植病人术中各个阶段血管外肺水(EVLw)的监测,了解其变化规律,分析可能影响EVLW的因素.方法 24例因终末期肝病行原位肝移植手术的患者,左侧肱动脉穿刺并置入5F热稀释导管,连接到PiCCO监护仪,监测血管外肺水、胸腔内血容量指数等参数.分别于手术开始前、无肝前期末、无肝期30 min、新肝期60 min、新肝期120 min和手术结束时记录上述各个血流动力学指标.结果 EVLW术前基础值明显高于正常值,术中虽有逐渐增加的趋势,但与术前相比差异无统计学意义(P>0.05),EVLW与ITBV呈正相关(r=0.822,P<0.05).结论肝移植病人术中EVLW变化轻微;肝移植术中EVLW明显高于正常值,这主要与循环血容量增加有关.
목적 통과맥박지시제련속심수출량(PiCCO)감호의대간이식병인술중각개계단혈관외폐수(EVLw)적감측,료해기변화규률,분석가능영향EVLW적인소.방법 24례인종말기간병행원위간이식수술적환자,좌측굉동맥천자병치입5F열희석도관,련접도PiCCO감호의,감측혈관외폐수、흉강내혈용량지수등삼수.분별우수술개시전、무간전기말、무간기30 min、신간기60 min、신간기120 min화수술결속시기록상술각개혈류동역학지표.결과 EVLW술전기출치명현고우정상치,술중수유축점증가적추세,단여술전상비차이무통계학의의(P>0.05),EVLW여ITBV정정상관(r=0.822,P<0.05).결론 간이식병인술중EVLW변화경미;간이식술중EVLW명현고우정상치,저주요여순배혈용량증가유관.
Objective To investigate the changes of extravaacular lung water during the perioperative period of orthotopic liver trans-plantation. Methods 24 consecutive patients with end-stage fiver disease undergoing orthotopie liver transplantation (OLT) were studied. In all patients a 5 French fiberoptic catheter with a thermistor was placed in the brachial artery and connected to the PiCCO system. Extravascular lung water (EVLW) and intrathoracic blood volume (ITBV) were monitored. After induction of anesthesia and achievement of stable hemodynamic and respiratory conditions, the baseline values of hemedynamic data, ITBV and EVLW were recorded. The patients were studied during the anhepatic stage, the Ist hour and 2nd hours after reperfusion of the graft. Final measurements of all the values were immediately determined after operation. Results EVLW remained statistically unchanged during the whole study period in all patients though all of them were increased, compared to normal values. EVWL was positively correlated with ITBV (r = 0. 822, P < 0. 05). Conclusion The changes of EVLW during perioperative period of orthotopic fiver transplantation were very little. Circulative volume overload may be perhaps the most important cause of the increase of EVLW.