Objective To research anesthetic management, pathophysiologic variation of adult-to-adult living donor liver transplantation (A-ALDLT) and to probe how to improve anesthetic quality of A-ALDLT. Methods The clinical data of 47 donors from Sep. 2005 to Jan. 2007 in West China Hospital were reviewed. Intraoperative vital signs, anesthetic management, perioperative serum levels of HGB， Alb， ALT， AST, TBIL， APTT， PT were measured， and complications were assessed. Results The physical condition of all donors were good before operations and were all in grade Ⅰaccording to ASA. Under general anesthesia of intravenous and inhalation, electrocardiogram, O2 saturation, blood pressure and body temperature were continuously monitored. A radial arterial catheter and a central venous catheter were placed. Blood lavement was utilized intraoperatively in all patients. All donors maintained stable life signs intraoperatively. The average intraoperative blood losses was （603.13±317.00） ml, and donors were transfused with autologous blood 〔(381.25±171.15) ml〕, with only 4 donors required homologous blood transfusion. HR and mean arterial blood pressure (MAP) showed no significantly variations intraoperatively (Pgt;0.05). Compared with controlled central venous pressure (CVP) before and right after hepatectomy, CVP increased significantly (P＜0.05) when intubation and abdomen-closing were carried. After hepatectomy and on the first day after operation, HGB and Alb decreased significantly (P＜0.05); ALT, AST and TBIL increased significantly (P＜0.05). Right after hepatectomy, PT increased instantly and significantly (P＜0.05); On the first day after operation, APTT began to increase significantly (P＜0.05). All donors came around completely and were extubated in the liver transplantation intensive care unit on the first day after operation. There were 3 cases (6.38%) of postoperative complication, which were biliary leakage, portal vein thrombosis and serious pleural effusion. Those 3 donors were cured after treatment. Conclusion Inhalation and intravenous general anesthesia of propofol, remifen-tanil and isoflurane can maintain stable life signs and reduce liver injury. Steady anesthesia, sufficient oxygenation and effective blood protection measures, for example, by decreasing CVP to prevent bleeding and by reclaiming autologous blood to avoid transfusing homologous blood, are keys for the safety of the donor and the prevention of complications.
ObjectiveTo investigate the effect of post-conditioning with fospropofol disodium on hepatic ischemiareperfusion (I/R) and its possible mechanism in rats. MethodsForty-eight Sprague-Dawley rats were randomly divided into four groups, including sham group (S), control group (C), propofol group (P) and fospropofol disodium group (F). According to the different periods after reperfusion, each group was further divided into 2-hour and 4-hour reperfusion subgroups respectively (n=6 in each subgroup), named S2h, C2h, P2h, and F2h subgroups and S4h, C4h, P4h, and F4h subgroups. The livers of rats were reperfused after hepatic ischemia for one hour. In the beginning of reperfusion, normal saline was infused intravenously in group S and group C continuously, propofol was infused intravenously in group P continuously, fospropofol disodium was infused continuously in group F. The blood was sampled at the end of ischemia and reperfusion for assay of alanine aminotransferase (ALT) and aspartate aminotransferase (AST). The bcl-2 and bax protein contents in liver tissue were detected by immunohistochemical analysis, and liver samples were stained with hematoxylin-eosine for histological observation and damage degree evaluation by counting the proportion of necrosis cells. ResultsThe activity of ALT and AST, the rate of necrosis cells and the amount of bcl-2 and bax protein after reperfusion in group C, group P and group F were higher than those in group S at matched reperfusion time points (P<0.05). The activity of ALT and AST, the proportion of necrosis cells and bax protein contents decreased in group P and group F, compared with group C at the same reperfusion time points, while the contents of bcl-2 protein were significantly increased (P<0.05). ConclusionFospropofol disodium can alleviate hepatic injury induced by ischemia-reperfusion in rats, in which the bcl-2 and bax protein may play important roles.
ObjectiveTo investigate whether emulsified isoflurane applied after an ischemic episode induces postconditioning in an ischemia model of myocardial injury and its underlying mechanism. MethodsBetween March and October 2012, using a model of in situ myocardial ischemia and reperfusion injury in rats, cardioprotective effects of emulsified isoflurane were examined by determining infarct size, myocardial damage markers and the concentration of tumor necrosis factor (TNF)-α. ResultsEmulsified isoflurane postconditioning limited infarct size compared with control groups. It increased serum concentrations of superoxide dismutase while decreased malonaldehyde. TNF-α positive cells were also significantly reduced in emulsified isoflurane group compared with control group. Infusion of intralipid had no effect on infarct size or other variables. ConclusionIntravenous administration of emulsified isoflurane after reperfusion protects hearts against reperfusion injury, which may be mediated by the inhibition of cardiac damage markers and the concentration of TNF-α.
目的 观察体外静脉静脉转流对患者血流动力学的影响。方法原位异体肝移植患者14例，术中使用离心泵，部分肝素化方法行体外静脉转流。结果 体外静脉转流时间（98.9±23.6）min，转流量（1 168±260）ml/min，转流期及新肝5分钟心排血量（CO）明显下降，但仍维持在正常水平，体循环阻力（SVR）、肺循环阻力（PVR）转流30分钟后明显增加，心率（HR）、平均动脉压（MAP）、中心静脉压（CVP）、平均肺动脉压（MPAP）、肺毛细血管楔压（PCWP）等在转流期均无明显变化，新肝早期MAP明显下降，SVR明显增加。结论 无肝期采用离心泵行体外静脉转流，有助于稳定血流动力学，但新肝早期仍有明显血压下降，主要通过适量快速泵灌注全血来纠正。
ObjectiveTo evaluate the changes in thrombelastography(TEG) during orthotopic liver transplantation （OLT） in Chinese. MethodsTwentyfive patients with cirrhosis of liver undergoing OLT were studied. They were composed of two groups: cirrhosis group （n=15） and liver neoplasm group （n=10）. Anesthesia was induced with propofol 1.5-2 mg/kg,fentanyl 3-5 μg/kg and vecuronium 0.1 mg/kg and maintained with isoflurane or enflurane inhalation.The operation was divided into three phases: ① before operation and preanhepatic phase （120 min after operation was started）, ② 30 min after liver was removed,③ 5 min before reperfusion and 5 min,15 min,30 min,60 min and 120 min after reperfusion.In 8 patients among the 25 patients heparinasecelite TEG was measured 5 min after reperfusion in addition to celite TEG.If there was significant differences in traces between the two TEG measurements,an intravenous bolus of 50-75 mg protamine was given and the heparinasecelite TEG was repeated.The measured variables included the r （reaction） time,representing the rate of initial fibrin formation K （coagulation） time, alpha angles （α） reflecting fibrinplatelet interaction, MA （maximal amplitude） indicating qualitative platelet function and percent fibrinolysis at 60 min. ResultsIn cirrhosis group changes in TEG occurred after liver was removed and in earlier period after reperfusion, while in liver neoplasm group changes in TEG were found in earlier period after reperfusion as compared with preoperative value.At 5 min after reperfusion there were significant differences in TEG （r，K，α and MA） values between celite and heparincelite TEG （P＜0.01）. ConclusionDuring OLT coagulation disorder occurs mainly at anhepatic and early reperfusion phase.
目的探讨肝移植后育龄妇女的怀孕及分娩对胎儿的影响。方法分析了中国大陆首例肝移植妇女肝移植、免疫抑制剂使用及成功怀孕和分娩的情况。 结果本例妇女因硬化性胆管炎，胆汁性肝硬化，肝脓肿，脾大而行同种原位肝移植术，术后2年9月第二次成功怀孕并分娩出发育正常的男婴。结论肝移植后育龄妇女同样可以正常怀孕，但是发生早产和胎儿发育相对迟缓的几率增加；怀孕过程中应该严密地监控母亲的器官功能改变和胎儿的发育情况，并且应合理选择和使用免疫抑制剂。
【摘要】目的 报道四川大学华西医院首例胰肾联合移植。方法 2007年3月我院对1例2型糖尿病合并肾功能衰竭患者成功施行了胰肾联合移植手术，将肾脏移植于左侧髂窝，胰腺移植于右侧髂窝，胰腺移植采用肠道-体循环回流术式。结果 术后第1 d C-肽升至正常水平，第4 d血肌酐恢复正常，第11 d血尿素氮恢复正常，血糖逐渐趋于稳定，第16 d完全停用胰岛素，术后3周OGTT结果显示移植胰腺功能正常。随访6个月移植胰腺、肾脏功能正常，没有发生手术相关并发症。结论 胰肾联合移植是治疗2型糖尿病合并肾功能衰竭的有效手段。