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題名 | Low-Flow Anesthesia in Adult Orthotopic Liver Transplantation:A Preliminary Clinical Experience=低流量麻醉於成人肝臟移植手術之運用:初期臨床經驗 |
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作者 | 徐魁堯; 譚培炯; 林志中; 陳介絢; 李俊毅; 楊承憲; 石明煌; | 書刊名 | 麻醉學雜誌 |
卷期 | 35:4 1997.12[民86.12] |
頁次 | 頁229-236 |
分類號 | 416.5 |
關鍵詞 | 麻醉:閉鎖式; 肝臟移植; 體溫; Anesthesia:Close-circuit; Liver transplantation; Body temperature; |
語文 | 英文(English) |
中文摘要 | 背景:低流量麻醉具有許多優點,特別是長時間麻醉。近年來肝臟移植手術在臺灣 有漸增加的趨勢,但臨床經驗仍然有限,它是一種耗時長、麻醉中變化多端的手術。文獻上, 關於低流量麻醉用於肝臟移植手術極少,本研究目的,在採計其可行性,並研究低流量麻醉 下,病患生理狀況與結果。 方法:自1996年六月,共有六位病患接受肝臟移植手術,全部使用isoflurane作低流量 麻醉,靜脈接合法均採用肝靜脈肝靜脈吻合術,有二位病患因手術方法改變(採用下腔靜脈截 流,及下腔靜脈下腔靜脈吻合術),摒除在本研究之外。麻醉誘導後,都採用低流量維持麻醉, 總流量為0.6L/min,使用氧氣與壓縮空氣混合氣體攜帶麻醉劑。麻醉中,除常規麻醉機與生 理監視器外,也使用一條新型Swan-Ganz導管,可以連續性作線上紀錄及輸出其心搏量、血 管阻力、肺動脈壓、中心靜脈與與中心體溫。此外,我們也在麻醉後、無肝期前後五分鐘、 灌流期前後五分鐘、以及手術結束前分別測量其動脈血氧氣體分析、電解質值、乳酸值與血 糖值。 結果:麻醉時間為916土26分鐘。所有病患都可以在手術結束後三十分鐘內恢復意識。 病人在低流量麻醉下有良好的體溫保存,都沒有發生缺氧或二氧化碳過高的情形,同時血氧 酸鹼值、血糖值及電解質值都在可接受之範圍,乳酸值隨手術進行逐漸增高,在肝臟再灌流 後達到最高點,手術結束前逐漸復原。血流動力學比較,發現肝臟在灌流後產生所謂的「再 灌流傷害」,血壓下降,同時心博量增加,但系統血管阻力下降。 結論:低流量麻醉由於可提供好的熱及濕度的保存,在肝臟移植手術麻醉中,中心體溫維 持極佳,其他生理變數也都維持在可接受範圍,本研究推論,低流量麻醉應在肝臟移植手術麻 醉佔有一席之地。 |
英文摘要 | Background: Anesthesia in orthotopic liver transplantation (OLT) may carry with complex hemodynamic, body temperature, and metabolic alterations. Although OLT cases increased in recent years in Taiwan, experiences remained limited. Notable advantage of low flow anesthesia may include reduced consumption of anesthetic gases and vapors, reduced environmental pollution and cost-saving. This study investigated patient profiles and the feasibility of low-flow rebreathing technique for adult orthotopic liver transplantation. Methods: Since June 1996, there were six OLT patients who received low flow anesthesia with isoflurane. All patients received hepatic veno-venal anastmosis (so-called piggy back procedure). Two patients were excluded from this study because of different surgical procedure (total occlusion of inferior vena cava and inferior vena cava veno-venal anastmosis). During maintenance of anesthesia, isoflurane was carried by a mixture of oxygen and air at a total fresh gas flow of 0.6 L/min. Alongside with the standard anesthesia machine and physiologic monitors, a newly designed Swan-Ganz catheter was introduced to measure and record cardiac output, systemic vascular resistance, pulmonary artery pressure, central venous pressure, and core temperature in a real-time manner. Blood samples were collected at 6 predetermined time-points in each patient for analysis of arterial blood gases, electrolytes, lactate and glucose concentrations. Results: The anesthetic time was 916 ± 26 min (900 to 930 min). All patients regained their consciousness within 30 min after completion of surgery. The hemodynamics were relatively stable except after reperfusion of the liver. There was a significant decrease in mean arterial blood pressure, which occurred with accompaniment of a reduction of systemic vascular resistance and increased cardiac output. Arterial blood gas, electrolyte, and glucose were, however, maintained within acceptable limits. Blood lactate was progressively increased and reached its peak after reperfusion of the liver until the end of surgery. The core temperature was well maintained above 34 ℃. No patient developed hypoxia or hypercapnia. Conclusions: Low-flow rebreathing anesthetic technique maintained acceptable patient profiles and good body temperature preservation in orthotopic liver transplantation. These characteristics make it a promising method in maintenance of anesthesia for OLT. |
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