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目的 探讨全肝血流阻断 (THVE)巨大肝肿瘤切除术围麻醉期血液动力学的调控措施。方法 10例全肝血流阻断下巨大肝肿瘤切除术病人 ,用多巴胺 (3～ 5 μg·kg- 1· min- 1 )支持心血管功能 ,阻断前输血补液 ,提高中心静脉压至 1.2 k Pa水平 ,采用Swan- Ganz导管技术监测围麻醉期血液动力学变化。结果 肝血流阻断后 ,CVP下降 (2 7.6 % ) ,HR增快 ,SVRI增加 (2 4.3% ) ,CI(17.8% )和 L VSWI(2 2 .6 % )明显下降 ,MAP仅下降 14.3% ,以阻断 5 min为甚 ,肝血流开放后 ,各参数均恢复稳定。结论 小剂量多巴胺支持循环 ,阻断前提高 CVP,阻断后快速输血补液 ,是防止 THVE引起的血液动力学剧变的有效措施
Objective To investigate the hemodynamic control measures during perioperative anesthesia with total hepatic vascular occlusion (THVE). Methods Ten patients with giant hepatic tumor undergoing total hepatic vascular occlusion were treated with dopamine (3 ~ 5 μg · kg-1 · min-1) to support cardiovascular function, blocking pre-transfusion fluids and increasing central venous pressure to 1.2 kPa level, using Swan-Ganz catheter monitoring perioperative anesthesia hemodynamic changes. Results After the hepatic blood flow was blocked, CVP decreased (2.76%), HR increased, SVRI increased (21.3%), CI (17.8%) and L VSWI decreased significantly (22.6% %, To block 5min is even more, the liver blood flow open, the parameters were stable. Conclusions Small doses of dopamine support circulation, increase CVP immediately before blockage, and rapidly transfusion rehydration after blockade is an effective measure to prevent dramatic hemodynamic changes caused by THVE