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时间:2019-05-24
《《不同灌注方法对原位肝移植麻醉的临床效果分析-论文》》由会员上传分享,免费在线阅读,更多相关内容在行业资料-天天文库。
1、现代生物医学进展www~hengwuyixue.comProgressinModernBiomedicineVoL14NO.7MA1~2014·1297·doi:10.13241~.cnki.pmb.2014.07.024不同灌注方法对原位肝移植麻醉的临床效果分析冰董刚任波△郭晓东徐晨刘芳婷李晶刘霞毕振华刘振文(解放军第302医院北京100039)摘要目的:观察下腔静脉逆灌注法与常规门静脉正向灌注法应用于经典非转流原位肝移植手术的临床效果,并比较两种灌注法对新肝期再灌注后综合征的影响。方法:回顾性分析我院行经典非转
2、流肝移植手术的患者60例,按照灌注方法的不同分为两组:A组(30例)采用下腔静脉逆灌注法;B~K(30例)采用门静脉正向灌注法。比较两组患者围手术期的血流动力学指标、体温、内环境的改变等情况。结果:①分别在新肝开放即刻、新肝期5分钟及15分钟观察两组患者的平均动脉压、肺动脉压楔压、心率变化程度及心脏指数,A组均小于B组,差异有统计学意义(P<0.05);②分别于新肝期5分钟及15分钟观察两组患者的中心静脉压,A组低于B组(P<0.01);③观察开放时两组患者的最低温度,A组高于B组(P<0.01);④观察血管活性药
3、物用量,A组少于B组,差异有统计学意义(P<0.05)。结论:经典非转流肝移植术中,采取逆灌注方法可减少术后再灌注综合征的发生。两种灌注方式均需要加强对血流动力学、体温、酸碱平衡的监测与调整,做到针对性的麻醉管理。关键词:经典非转流肝移植;麻醉;灌注方法;再灌注综合征中图分类号:R575文献标识码:A文章编号:1673—6273(2014)07—1297.03ClinicalAnalysisaboutDifferentMethodsofRetrogradePerfusionforAnesthesiaOntheOrt
4、hotopicLiverTransplantation*DONGGang,RENBo△.GUOXiao-dong,XUChert,LIUFang-ting,LIJing,LIUa,BIZhen-hua,LIUZhen—WOn(302HospitalofPLA,Beijing,100039,Chim)ABSTRACTObjective:Toobservetheapplicationsofdiferentretrogradeperfusionmethodsontheorthotopiclivertransplantat
5、ionwithoutvenousbypass,andtocomparetheclinicalefectsonthepostreperfusionsyndrome.Methods:Sixtypatientswithorthotopiclivertransplantationwhoweretreatedinourhospitalwereselectedandrandomlydividedintotwogroupsaccordingtodiferent—perfusionmethods.GroupAwith30cases
6、,wereunclampedbeforeportalanastomosis,whilegroupBwithanother30caseswereperformedthenormalperfusionsviaportalveins.Thehemodynamicparameters,bodytemperature,changesofintemalenvironmentandfluidtherapyofpatientswerecomparedbetweenthetwogroups.Results:①Thechangesin
7、systolicbloodpressure,diastolicbloodpressureandheartrateingroupAwerelessthanthoseofgroupBatthebeginningofneohepaticphase,thefifthminutesandthefifteenthmunitesrespectively.andtherewerestatisticallysignificantdiferencesbetweentwogroups(P8、ressurewassignificantlylowerthanthatofgroupBatthefifthandtenthminutesofneohepaticphase,andtherewasstatisticallysignificantdiferencebetweentwogroups(P<0.05);③Attheearlyneohepaticsta
8、ressurewassignificantlylowerthanthatofgroupBatthefifthandtenthminutesofneohepaticphase,andtherewasstatisticallysignificantdiferencebetweentwogroups(P<0.05);③Attheearlyneohepaticsta
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