肝移植 , 氧代谢 , Pugh-Child 分级

Objective To investigate the effects of oxygen delivery（DO2）-directed hemodynamicmanagement on oxygen metabolism during orthotropic liver transplantation（OLT）without veno-venous bypass in thepatients with different degrees of hepatic insufficiency. Methods 50 patients scheduled non veno-venous bypassOLT were divided into 3 groups according to the Pugh-Child scores ，class A（group A，12 patients），class B（groupB，18 patients），class C（group C，20 patients）. Left radial artery was cannulated before induction of anesthesia，then Swan-Ganz catheter was inserted in the pulmonary artery via right internal jugular vein. Cardiac index（CI）wasmaintained more than 50 ml/（s·m2）and mean arterial pressure more than 60 mm Hg（1 mm Hg＝0.133 kPa）in allpatients. Arterial partial pressure of oxygen（PaO2），mixed venous saturation（SvO2），CI，DO2，oxygen consumption（VO2）and oxygen extract rate（ERO2）were measured or calculated after anesthesia and before surgical incision（T1，baseline），at 10 minutes before anhepatic phase（T2），30 minutes after onset of anhepatic phase（T3），30 minutesafter neohepatic phase（T4）and the end of surgical procedure（T5）. Results In the three groups，VO2，SvO2，and DO2 during T3 showed substantial decrease in comparison with T1（P＜0.05 or P＜0.01），then VO2 markedly increasedduring T4 in comparison with T3（all P ＜ 0.05），which recovered to T1 up to the end of T5. ERO2 increased significantlyduring the T3 in comparison with T1 in group B and C（both P ＜ 0.05）. Moreover，there were significant differences amongthree groups during T3，which mainly manifested the SvO2 and DO2 were much lower in group B and C than in group A，while ERO2 was much higher in group B and C than group A（all P ＜ 0.05）. The length of hospital stay was increasedsequentially from group A to group C. Conclusions The tendency of the whole changes in oxygen metabolism of thepatients with different degrees hepatic insufficiency during OLT is consistent during DO2-directed management patterns ofhemodynamics，and abnormality of oxygen metabolism occurs more severely in anhepatic phase. The changes of DO2 andERO2 in patients with Pugh-Child scores Class B and C were more serious than Class A.

Liver transplantation, Oxygen metabolism, Pugh-Child scores