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

目的 观察以氧供（DO2）为导向的血流动力学管理模式在不同程度肝功能损害患者非转流经典原位肝移植手术过程中机体氧代谢变化。方法 选择接受经典非转流肝移植术患者 50 例，按 Pugh-Child评分法分为 A 级（A 组，12 例）、B 级（B 组，18 例）、C 级（C 组，20 例）。左桡动脉置管后常规麻醉诱导，经右颈内静脉放置 Swan-Ganz 导管。术中维持心排血指数（CI）＞ 50 ml/（s·m2），平均动脉压（MAP）≥60 mm Hg（1 mm Hg＝0.133 kPa）。分别在麻醉后手术前（T1），无肝期前 10 分钟（T2），无肝期 30 分钟（T3），新肝期 30 分钟（T4）及术毕（T5），采集桡动脉血和肺动脉的混合静脉血监测和计算以上各时点的动脉血氧饱和度（SaO2）、动脉血氧分压（PaO2）、混合静脉血氧饱和度（SvO2）、CI、DO2、氧耗（VO2）及氧摄取率（ERO2）。结果3 组患者在 T3 时 VO2、SvO2 和 DO2 均明显低于 T1 时（P＜0.05 或 P＜0.01）。3 组 VO2 在 T4时上升，明显高于 T3 时（均 P＜0.05），T5 时恢复至 T1 时水平。B、C 组的 ERO2 在 T3 时均明显高于 T1 时（均P＜0.05）。T3 时 B、C 组的 SvO2 和 DO2 低于 A 组（均 P＜0.05），ERO2 则明显高于 A 组（均 P＜0.05）。术后住院天数 A、B、C 组依次递增。结论 以 DO2 为导向的血流动力学管理模式，对不同程度肝功能损害患者肝移植术中机体氧代谢整体变化趋势一致，均以无肝期异常最为严重。Pugh-Child 分级 B 级和 C 级患者DO2和 ERO2 变化较 A 级患者更为剧烈。

肝移植 , 氧代谢 , Pugh-Child 分级