Abstract:

Objective To retrospectively summerize the anesthetic characteristics in 85 infants and children undergoing living related partial liver transplantation admitted to Tianjin First Center Hospital from January 2010 to October 2013. Methods 85 cases of the American Society of Anesthesiologists (ASA) HI or IV elective pro-donor liver transplantation in children, into the operating room oxygen mask, upper extremity venous channels were open in the ward. Intravenous injection of ketamine 0.15-0.20 mg/kg, midazolam 0.10-0.15 mg/kg, fentany 2-5 pg/kg and vecuronium 0.8-1.0 mg/kg induction of anesthesia. Preoperative intravenous access without children section, intramuscular ketamine 5—10 mg/kg, sevoflurane, open upper extremity venous channels ; intermittent intravenous fentanyl 1-3 pg/kg, vecuronium 0.3-0.5 mg/kg, inhalation of 1.0% to 1.5% sevoflurane anesthesia. Intravenous infusion of dopamine 1-5 pg/ (kg ? min), nitroglycerin 0.2-0.5 (kg ? min) or intravenous epinephrine 5—20 pg or 40-100 jxg of phenylephrine to maintain loop stability. The temperature was maintained with heating devices such as heating bed, heating blanket and fluid warming. Heart rate (HR), electrocaradiogram (ECG), pulse oxygen saturation (SpO₂), mean arterial pressure (MAP), central venous pressure(CVP)were monitored.Blood gas analysis〔 pH value, arterial partial pressure of oxygen (Pa0₂), arterial partial pressure of carbon dioxide (PaC0₂), base excess (BE) J, blood K⁺, Ca" and glucose levels were determined. The prothrombin time, partial prothrombin time, activated partial prothrombin time and fibrinogen levels were also measured. Results Inferior vena cava occlusion time was 40-62 minutes. The durations of portal circulation interruption and surgery were 43-72 minutes, 240-500 minutes. 84 patients were discharged from the hospital. One patient died 6 days after operation because of acute rejection. There were severe pneumonia in 2 patients, and biliary fistula in 4 patients after operation. Conclusion Intraoperative insulation, smooth induction and maintenance of anesthesia, ultrasound guided internal jugular vein catheterization, perioperative hemodynamic stable, effective liver, kidney, heart protective measures to adjust monitor blood gas and electrolytes, coagulation function key management and immunosuppressant and fliers are key issues to ensure the success of pediatric liver transplantation.

摘要：

目的 回顾总结2010年1月至2013年10月在天津市第一中心医院85例婴幼儿亲体肝移植 术的麻醉处理特点。方法85例美国麻醉医师协会(ASA)DI或IV级择期亲体肝移植术患儿，入手术室后 面罩吸氧，上肢静脉通道在病房已开放；静脉注射氯胺酮0.15 -0.20 mg/kg、咪达哩仑0.10 ~ 0.15mg/kg、 芬太尼2 ~ 5 pig/kg和维库漠俊0.8 - 1.0 mg/kg麻醉诱导；术前无静脉通道部分患儿，肌肉注射氯胺酮5 ~ 10 mg/kg、吸入七氟醍，开放上肢静脉通道；间断静脉注射芬太尼1 ~ 3皿g、维库漠俊0.3 ~ 0.5 mg/kg、 吸入1.0% ~ 1.5%七氟醵维持麻醉。静脉输注多巴胺1 ~ 5闸(kg ? min )、硝酸甘油0.2 ~ 0.5 pg/( kg ? min ) 或静脉注射肾上腺素5 ~ 20明或去氧肾上腺素40 - 100昭维持循环稳定。术中采用加温床、加热毯和加温 输液仪等进行保温处理。术中监测心率、心电图、脉搏血氧饱和度、有创动脉血压和鼻咽温度；进行动脉 血气分析(pH、氧分压、二氧化碳分压、剩余碱)，测定血钾、血钙、血糖、凝血酶原时间、凝血酶时间、 活化部分凝血活酶时间和纤维蛋白原。结果 下腔静脉阻断时间为40 ~ 62分钟，门静脉阻断时间为43 ~ 72分钟，手术时间为240 ~ 500分钟。84例患儿痊愈出院，术后1例发生急性排斥反应，于术后6天死亡。 术后并发症：2例术后发生重症肺炎，4例患儿发生手术后胆痿。结论 术中保温、平稳地麻醉诱导和维持、 超声引导颈内静脉置管、围手术期维持稳定的血流动力学、有效的肝、肾、心脏保护措施、及时调整血气 和电解质、凝血功能的监测和管理及免疫抑制剂等均是保证小儿肝移植术成功的关键。