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1、解放军医学杂志2006年11月第31卷第11期MedJChinPLAVol31No11November2006#1109#肝肾胰联合移植手术的麻醉及围术期管理陈绍洋聂煌熊利泽胡胜曾毅王强朱萧玲张维摘要目的探讨肝、肾、胰联合移植手术的麻醉及围术期管理方法。方法肝肾胰联合移植患者1例,行充分术前准备,改善肝功能,减轻尿毒症症状,控制血糖水平,使患者各脏器功能处于最佳状态。选用异氟烷、咪唑安定、芬太尼和维库溴铵行静脉吸入复合麻醉,维持合适麻醉深度和充分供氧。行桡动脉和颈内静脉穿刺置管,用于监测血压和维持静脉通道;选用食管超声多普勒行血流动力学监测;定时检测肝、肾功能
2、指标、凝血参数、动脉血气、血糖浓度以及血、尿淀粉酶等生化参数,根据上述检测结果调整治疗。结果术中循环稳定,血气结果正常。术毕时血糖浓度较术前升高。患者肝脏及胰腺功能在术后1周恢复正常。肾脏功能恢复不良,予以二次肾移植术,两次手术期间行血液透析。肾功能于二次肾移植术后第3天恢复正常。目前患者各脏器功能正常。结论肝胰肾联合移植麻醉及管理的重点是充分术前准备,选择静吸复合麻醉,兼顾各脏器功能,维持血流动力学和内环境稳态的平衡。关键词肝肾胰移植;麻醉;围术期管理中国图书资料分类号R614Anesthesiaandperioperativemanagementforsimultane
3、ousliverkidneypancreastransplantation:areportofonecaseChenShaoyang,NieHuang,XiongLizeetalDepartmentofAnesthesiology,XijingHospital,FourthMilitaryMedicalUniversity,Xian710032,ChinaAbstractObjectiveToevaluatetheanesthesiaandperioperativetreatmentforsimultaneousliverkidneypancreastransplantat
4、ion.MethodsThepreoperativepreparationincludedimprovementofthehepaticfunction,alleviationofuremiaandcontrolofbloodglucoselevel.Generalanesthesiawasemployedandmaintainedwithisofluranecombinedwithintermittentintravenousadministrationofmidazolam,fentanylandvecuronium.Dopamineandlowdoseofepinephrinewe
5、reusedtomaintainarterialbloodpressureifnecessary.Theparametersofbloodcoagulation,theindexesofhepaticandrenalfunction,bloodglucoseandamylaselevelsinbloodandurineweresurveyedregularly.Thetreatmentwasadjustedaccordingtotheresultsoftestsmentionedabove.ResultsThecirculationwasstableandbloodgaswasnorm
6、alinthecourseofsurgery.Theconcentrationofbloodglucosewashigherattheendoftheoperationthanthatofpreoperation.Normalhepaticandpancreaticfunctionwasachievedaboutaweekafteroperation,whiletherenalfunctionshowednosatisfactoryimprovement.Thepatientwasgivenhemodialysisuntilthesecondtransplantationofkidn
7、ey.Threedayslater,therenalfunctionrecoveredtonormal.Uptothepresent,allthegraftedorgansshowedgoodfunction.ConclusionAppropriatepreoperativepreparation,optimalanestheticprocedureandmanagement,perfectprotectionoff
