Changes in pulmonary gas exchange and intrapulmonary shunt during orthotopic liver transplantation.
- VernacularTitle:原位肝移植术中肺氧合功能的变化
- Author:
Huan ZHANG
;
Baxian YANG
;
Deshui YU
- Publication Type:Journal Article
- Keywords:
Liver transplantation;
Pulmonary circulation;
Oxygen consumption
- From:
Chinese Journal of Anesthesiology
1996;0(08):-
- CountryChina
- Language:Chinese
-
Abstract:
Objective To evaluate the changes of pulmonary gas exchange and intrapulmonary shunt during orthotopic liver transplantation (OLT) Methods Eleven ASA Ⅲ Ⅳ patients (male 8, female 3) with end stage liver diseases were studied Age ranged from 17 67 yr Anesthesia was induced with midazolam 0 1 mg?kg -1 , fentanyl 5?g?kg -1 and pipecuronium 0 1 mg?kg -1 and maintained with isoflurane inhalation and intermittent iv boluses of fentanyl and pipecuronium combined with epidural anesthesia (T 8 9 ) The patients were mechanically ventilated with 100% O 2 during operation After induction of anesthesia Swan Ganz catheter was inserted via right internal jugular or subclavian vein Cardiac output (CO),mixed venous oxygen saturation and core venous temperature were continuously monitored with continuous cardiac output monitor (Baxter,Vigilance) ECG, CVP, SpO 2 and P ET CO 2 were also continuously monitored during operation Radial artery was cannulated for continuous direct blood pressure monitoring Arterial and mixed venous blood samples were taken at the beginning of operation, 120 min during preanhepatic stage, 30 and 60 min during anhepatic stage, 5 and 60 min during neohepatic stage and at the end of operation Alveolar arterial oxygen partial pressure difference (A aDO 2) , intrapulmonary shunt (Qs/Qt) , oxygen delivery index (DO 2I) and oxygen consumption (VO 2 I ) were calculated During operation body temperature was maintained above 35 5℃ Veno venous bypass (VVB) was performed during anhepatic stage Results At the beginning of operation, when FiO 2 was 100%, PaO 2 was only (376?141) mmHg, A aDO 2 and Qs/Qt were all higher than normal values There were no significant changes in all parameters 120 min during preanhepatic stage as compared with those at the beginning of operation PaO 2 increased and A aDO 2 and VO 2I decreased significantly during anhepatic stage Qs/Qt, A aDO 2 and PaCO 2 increased and PaO 2 decreased significantly, but there were no significant changes in cardiac index, DO 2I and VO 2I during early neohepatic stage Cardiac index, DO 2I and VO 2I increased at 60 min during neohepatic stage and at the end of operation Conclusions There are severe changes of pulmonary gas exchange during OLT
