中国危重病急救医学
中國危重病急救醫學
중국위중병급구의학
CHINESE CRITICAL CARE MEDICINE
2011年
7期
409-412
,共4页
肝移植,活体%儿童%血流动力学%电解质
肝移植,活體%兒童%血流動力學%電解質
간이식,활체%인동%혈류동역학%전해질
Living donor liver transplantation%Children%Haemodynamics%Electrolyte
目的 观察儿童活体肝移植围手术期血流动力学和电解质的变化,以寻找其防治措施.方法 采用自身前后对照研究,监测并分析20例活体肝移植患儿术前及术后1、3、5、7 d的血流动力学和电解质变化,结果与术前相比,术后1、3、5、7 d收缩压(SBP)、舒张压(DBP)及平均动脉压(MAP)均显著升高(SBP (mm Hg,1 mm Hg=0.133 kPa):106.60±9.58、116.75±9.11、117.95±12.15、116.45±8.73比92.75±6.72,DBP(mm Hg):63.85±10.33、70.70±10.98、70.90±12.92、74.65±15.51比53.95±12.43,MAP (mm Hg):78.15±9.30、85.30±9.44、85.35±13.85、85.90±13.94比66.45±8.83,均P<0.05],心率(HR,次/min)在术后5 d明显降低(102.80±26.08比117.25±19.25,P<0.05);术后1 d血Na+(mmol/L)显著升高(146.52±5.89比139.36±3.91,P<0.01),血K+、Ca2+显著降低[K+(mmol/L):3.36±0.44比4.12±0.68,Ca2+(mmol/L);1.15±0.15比1.23±0.06,P<0.01和P<0.05),而术后3、5、7 d血Na+、K+、Ca2+变化不明显;术后1、3、5、7 d血Mg2+(mmol/L)显著降低(0.69±0.11、0.64±0.10、0.58±0.10、0.72±0.17比0.84±0.10,P<0.05或P<0.01).结论 儿童活体肝移植围手术期血流动力学变化以血压升高为主,术后早期电解质不稳定;早期诊断和治疗高血压、调控好电解质对提高移植成功率非常重要.
目的 觀察兒童活體肝移植圍手術期血流動力學和電解質的變化,以尋找其防治措施.方法 採用自身前後對照研究,鑑測併分析20例活體肝移植患兒術前及術後1、3、5、7 d的血流動力學和電解質變化,結果與術前相比,術後1、3、5、7 d收縮壓(SBP)、舒張壓(DBP)及平均動脈壓(MAP)均顯著升高(SBP (mm Hg,1 mm Hg=0.133 kPa):106.60±9.58、116.75±9.11、117.95±12.15、116.45±8.73比92.75±6.72,DBP(mm Hg):63.85±10.33、70.70±10.98、70.90±12.92、74.65±15.51比53.95±12.43,MAP (mm Hg):78.15±9.30、85.30±9.44、85.35±13.85、85.90±13.94比66.45±8.83,均P<0.05],心率(HR,次/min)在術後5 d明顯降低(102.80±26.08比117.25±19.25,P<0.05);術後1 d血Na+(mmol/L)顯著升高(146.52±5.89比139.36±3.91,P<0.01),血K+、Ca2+顯著降低[K+(mmol/L):3.36±0.44比4.12±0.68,Ca2+(mmol/L);1.15±0.15比1.23±0.06,P<0.01和P<0.05),而術後3、5、7 d血Na+、K+、Ca2+變化不明顯;術後1、3、5、7 d血Mg2+(mmol/L)顯著降低(0.69±0.11、0.64±0.10、0.58±0.10、0.72±0.17比0.84±0.10,P<0.05或P<0.01).結論 兒童活體肝移植圍手術期血流動力學變化以血壓升高為主,術後早期電解質不穩定;早期診斷和治療高血壓、調控好電解質對提高移植成功率非常重要.
목적 관찰인동활체간이식위수술기혈류동역학화전해질적변화,이심조기방치조시.방법 채용자신전후대조연구,감측병분석20례활체간이식환인술전급술후1、3、5、7 d적혈류동역학화전해질변화,결과여술전상비,술후1、3、5、7 d수축압(SBP)、서장압(DBP)급평균동맥압(MAP)균현저승고(SBP (mm Hg,1 mm Hg=0.133 kPa):106.60±9.58、116.75±9.11、117.95±12.15、116.45±8.73비92.75±6.72,DBP(mm Hg):63.85±10.33、70.70±10.98、70.90±12.92、74.65±15.51비53.95±12.43,MAP (mm Hg):78.15±9.30、85.30±9.44、85.35±13.85、85.90±13.94비66.45±8.83,균P<0.05],심솔(HR,차/min)재술후5 d명현강저(102.80±26.08비117.25±19.25,P<0.05);술후1 d혈Na+(mmol/L)현저승고(146.52±5.89비139.36±3.91,P<0.01),혈K+、Ca2+현저강저[K+(mmol/L):3.36±0.44비4.12±0.68,Ca2+(mmol/L);1.15±0.15비1.23±0.06,P<0.01화P<0.05),이술후3、5、7 d혈Na+、K+、Ca2+변화불명현;술후1、3、5、7 d혈Mg2+(mmol/L)현저강저(0.69±0.11、0.64±0.10、0.58±0.10、0.72±0.17비0.84±0.10,P<0.05혹P<0.01).결론 인동활체간이식위수술기혈류동역학변화이혈압승고위주,술후조기전해질불은정;조기진단화치료고혈압、조공호전해질대제고이식성공솔비상중요.
Objective To explore the preventive measures of disturbances of haemodynamics and electrolytes by observing their changes during perioperative period of living donor liver transplantation in children.Methods Twenty children who had undergone living donor liver transplantation operation wereenrolled in the study,their haemodynamics and electrolyte parameters before operation and on the 1,3,5and 7 days after the operation were monitored and analyzed.Results Compared with levels before operation,systolic blood pressure(SBP),diastolic blood pressure(DBP)and mean arterial pressure(MAP)significantly increased on the 1,3,5 and 7 days after the operation [SBP(mm Hg,1 mm Hg=0.133 kPa):106.60±9.58,116.75±9.11,117.95±12.15,116.45±8.73 vs.92.75±6.72,DBP(mm Hg): 63.85±10.33,70.70±10.98,70.90±12.92,74.65±15.51 vs.53.95±12.43,MAP(mm Hg):78.15±9.30,85.30±9.44,85.35±13.85,85.90±13.94 vs.66.45±8.83,all P<0.05],but the heart rate(HR,bpm)was significant lowered only on 5 days after the operation(102.80±26.08 vs.117.25±19.25,P<0.05).Blood Na+(mmol/L)level rose significantly on the 1 day after the operation(146.52±5.89 vs.139.36±3.91,P<0.01).On the same day,blood K+ and Ca2+ were declined significantly[K+(mmol/L):3.36±0.44 vs.4.12±0.68,Ca2+(mmol/L):1.15±0.15 vs.1.23±0.06,P<0.01 and P<0.05],but there was no obvious change in them on 3,5 and 7 days.Significant decrease in blood Mg2+(mmol/L)was found on the 1,3,5 and 7 days after the operation(0.69±0.11、0.64±0.10、0.58±0.10、0.72±0.17 vs.0.84±0.10,P<0.05 or P<0.01).Conclusion Hypertension is the main haemodynamics change during perioperative period of living donor liver transplantation in children,and the levels of electrolytes are not stable in early postoperative period of liver transplantation.Early diagnosis and treatment of hypertension is important for children to recover from operation,and it is also important to maintain normal levels of electrolytes to obtain a successful liver transplantation.
