Perioperative volume and circulation management of living donor liver transplantation

doi:10.3760/cma.j.issn.1674-0793.2010.01.108

Abstract

Abstract:

Objective

To summarize and analysis the perioperative anesthesia management experience of 18 living donor liver transplantation cases.

Methods

A retrospective analysis about clinical data of 18 living donor liver transplantation cases from May 2007 to October 2008 in our hospital were made. Among these, 17 were male and 1 was female, including 9 cases of liver cancer, chronic severe hepatitis 9 cases of liver cirrhosis. All receptors were accepted right liver transplantation using piggyback operation.

Results

All liver transplant surgery of 18 cases were successful. The operative time were (10.5±1.6) hours, anhepatic phases was (100±15) minutes. Intraoperation blood loss were (3240±268) ml. Neohepatic phase of liver hemodynamic parameters recovered quickly. In neohepatic phase and the end of anhepatic phases coagulation function improved significantly. Five cases appeared hypokalemia and 3 appeared hyperkalemia, 6 of them appeared hypocalcemia. Metabolic acidosis often occured in the operation, especially in the end of anhepatic phases and 1-5 minutes of neohepatic phase(P<0.05).

Conclusions

Anhepatic phases of living donor liver transplantation last a longer time. More attention should be paid to correct the hemodynamics and water-electrolyte imbalance due to ischemia reperfusion injury in neohepatic phase. The improvement of coagulation function, homestasis will be benefical to cases.

Key words: Liver transplantation, Perioperative period, Hemodynamics, Water-electrolyte imbalance, Coagulation function, Living

Jian-qi WEI, Gang-jian LUO, Jian-qiang GUAN, Zi-qing HEI. Perioperative volume and circulation management of living donor liver transplantation[J]. Chinese Archives of General Surgery(Electronic Edition), 2010, 04(01): 28-31.

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References 8

1	严律南, 文天夫, 李波, 等. 成人成人间活体肝移植一例报告. 中华肝胆外科杂志, 2002, 8(10): 634-635.
2	Tanaka K, Kaihara S. Living-donor liver transplantation. Chirurg, 2003, 74(10): 944-950.
3	Niemann CU, Hirose R, Stock P, et al. Intraoperative fluid management of living donor versus cadaveric liver transplant recipients. Transplant Proc, 2004, 36(5): 1466-1468.
4	黑子清. 肝脏移植麻醉学. 广州: 中山大学出版社, 2006.
5	陈规划, 陆敏强, 何晓顺, 等. 改良背驮式肝移植69例报告. 中国实用外科杂志, 2002, 22(7): 405-407.
6	Trotter JF, Wachs M, Everson GT, et al. Adult-to-adult transplantation of the right hepatic lobe from a living donor. N Engl J Med, 2002, 346(14): 1074-1082.
7	罗晨芳, 黑子清, 罗刚健, 等. 重型肝炎肝移植围术期血流动力学变化及监测意义. 中国危重病急救医学, 2004, 16(12): 727-729.
8	Bismuth H. Surgical anatomy and anatomical surgery of the liver. World J Surg, 1982, 6(1): 3-9.

?	pH	BE(mmol/L)	K⁺(mmol/L)	Ca²⁺(mmol/L)	Glu(mmol/L)
麻醉后	7.41±0.04	2.1±0.2	3.9±0.6	1.2±0.3	6.9±2.4
无肝前期	7.36±0.02	1.48±0.45	4.0±0.3	1.3±0.4	9.8±3.1
无肝15 min	7.26±0.16^*#	-4.12±0.36^*#	3.1±0.2	0.9±0.1	10.3±0.5
无肝30 min	7.23±0.15^*#	-6.7±0.23^*#	3.0±0.4	0.9±0.2	11.2±0.6^*#
无肝60 min	7.28±0.08^*	-4.61±1.19^*	3.5±1.6	1.3±0.6	11.9±2.9^*#
新肝5 min	7.23±0.06^*	-7.3±1.2^*	3.4±1.2	1.2±0.5	12.0±1.6^*#
新肝15 min	7.3±0.05^*#	-6.2±1.1^*#	3.6±1.4	1.16±0.3	12.5±1.3^*#
新肝30 min	7.36±0.05^*	-6.2±1.3^*#	3.5±1.3	1.2±0.2	12.3±1.1^**#
新肝60 min	7.39±0.05^*	-5.69±1.99^*#	3.6±0.5	0.9±0.7^*	10.3±4.2^*
术毕	7.39±0.04	-1.45±0.73	3.9±0.8	1.6±0.9	11.3±2.5

?	pH	BE(mmol/L)	K⁺(mmol/L)	Ca²⁺(mmol/L)	Glu(mmol/L)
麻醉后	7.41±0.04	2.1±0.2	3.9±0.6	1.2±0.3	6.9±2.4
无肝前期	7.36±0.02	1.48±0.45	4.0±0.3	1.3±0.4	9.8±3.1
无肝15 min	7.26±0.16^*#	-4.12±0.36^*#	3.1±0.2	0.9±0.1	10.3±0.5
无肝30 min	7.23±0.15^*#	-6.7±0.23^*#	3.0±0.4	0.9±0.2	11.2±0.6^*#
无肝60 min	7.28±0.08^*	-4.61±1.19^*	3.5±1.6	1.3±0.6	11.9±2.9^*#
新肝5 min	7.23±0.06^*	-7.3±1.2^*	3.4±1.2	1.2±0.5	12.0±1.6^*#
新肝15 min	7.3±0.05^*#	-6.2±1.1^*#	3.6±1.4	1.16±0.3	12.5±1.3^*#
新肝30 min	7.36±0.05^*	-6.2±1.3^*#	3.5±1.3	1.2±0.2	12.3±1.1^**#
新肝60 min	7.39±0.05^*	-5.69±1.99^*#	3.6±0.5	0.9±0.7^*	10.3±4.2^*
术毕	7.39±0.04	-1.45±0.73	3.9±0.8	1.6±0.9	11.3±2.5

组别	HR(bpm)	MABP(mm Hg)	MPAP(mm Hg)	CVP(mm Hg)	PAWP(mm Hg)	CO(L/min)
麻醉后	80.8±15.6	74.9±10.4	20.6±6.4	7.7±3.6	13.3±4.0	7.81±1.25
无肝前	98.0±9.8^*	79.5±10.5	19.7±7.2	6.6±2.6	13.4±5.8	8.51±2.30^*
无肝5 min	109.8±17.5^#*	73.4±9.1^#	10.8±4.0^#*	1.5±3.5^#*	4.9±3.6^#*	3.34±1.70^#
无肝30 min	113.4±17.8^#*	79.5±9.7	11.5±3.7^#*	1.3±4.1^#*	4.1±4.2^#*	3.36±1.54^#*
新肝1 min	107.4±16.7^*	56.7±23.0^#	22.9±8.2	6.6±4.5^*	10.2±6.7^*	4.52±1.421^#*
新肝3 min	110.9±13.2^#*	76.0±26.2	24.8±6.7^#	7.8±3.3^#	11.2±5.6	4.56±1.45^#*
新肝5 min	107.2±9.9^#*	88.5±17.0	25.5±7.8^#	7.1±3.0^#*	11.6±6.0^*	4.97±2.20^#*
新肝7 min	106.0±9.3^#*	87.0±15.9	27.5±6.9^#*	7.3±3.4^#*	15.2±6.6^*	5.62±2.41^#
新肝15 min	102.3±9.3^*	85.2±9.1^*	27.2±10.0^#	7.2±5.3^#*	15.2±6.5^*	8.22±3.04
新肝30 min	95.7±8.5^*	79.2±11.0	27.6±7.7^#*	7.2±3.0^#*	15.4±4.1^#*	8.12±2.11^#*
新肝60 min	95.3±7.4^*	77.7±8.7	24.8±5.8^#	7.5±2.6^#*	15.8±5.1^*	8.66±3.31^*
术毕	95.2±6.6^*	77.3±10.2	23.5±5.1	7.6±2.1^*	16.0±4.1^*	9.13±2.46^#*

组别	HR(bpm)	MABP(mm Hg)	MPAP(mm Hg)	CVP(mm Hg)	PAWP(mm Hg)	CO(L/min)
麻醉后	80.8±15.6	74.9±10.4	20.6±6.4	7.7±3.6	13.3±4.0	7.81±1.25
无肝前	98.0±9.8^*	79.5±10.5	19.7±7.2	6.6±2.6	13.4±5.8	8.51±2.30^*
无肝5 min	109.8±17.5^#*	73.4±9.1^#	10.8±4.0^#*	1.5±3.5^#*	4.9±3.6^#*	3.34±1.70^#
无肝30 min	113.4±17.8^#*	79.5±9.7	11.5±3.7^#*	1.3±4.1^#*	4.1±4.2^#*	3.36±1.54^#*
新肝1 min	107.4±16.7^*	56.7±23.0^#	22.9±8.2	6.6±4.5^*	10.2±6.7^*	4.52±1.421^#*
新肝3 min	110.9±13.2^#*	76.0±26.2	24.8±6.7^#	7.8±3.3^#	11.2±5.6	4.56±1.45^#*
新肝5 min	107.2±9.9^#*	88.5±17.0	25.5±7.8^#	7.1±3.0^#*	11.6±6.0^*	4.97±2.20^#*
新肝7 min	106.0±9.3^#*	87.0±15.9	27.5±6.9^#*	7.3±3.4^#*	15.2±6.6^*	5.62±2.41^#
新肝15 min	102.3±9.3^*	85.2±9.1^*	27.2±10.0^#	7.2±5.3^#*	15.2±6.5^*	8.22±3.04
新肝30 min	95.7±8.5^*	79.2±11.0	27.6±7.7^#*	7.2±3.0^#*	15.4±4.1^#*	8.12±2.11^#*
新肝60 min	95.3±7.4^*	77.7±8.7	24.8±5.8^#	7.5±2.6^#*	15.8±5.1^*	8.66±3.31^*
术毕	95.2±6.6^*	77.3±10.2	23.5±5.1	7.6±2.1^*	16.0±4.1^*	9.13±2.46^#*

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[9]	Binsheng Fu, Xiao Feng, Qing Yang, Kaining Zeng, Jia Yao, Hui Tang, Jianrong Liu, Xuxia Wei, Huimin Yi, Shuhong Yi, Guihua Chen, Yang Yang. Application of donor liver with steatosis in adult split liver transplantation [J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2024, 13(06): 789-794.
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