经典非转流术式对原位肝移植术中患者体温的影响.DOCVIP

临床医学论文-经典非转流术式对原位肝移植术中患者体温的影响 ?????????????? 作者： 赵海萍，李爱民，冯国辉 ［摘要］? 目的? 通过观察经典非转流原位肝移植术中患者体温变化的规律，提供有效的体温保护措施。方法? 将15例晚期肝病患者，ASA Ⅲ～Ⅳ级，择期行OLT手术，麻醉诱导后使用Baxter Vigilance连续心输出量测定仪连续测定心输出量（CO），混合静脉血氧饱和度及中心静脉血温，监测ECG、CVP、PETCO2、SpO2、桡动脉压、肺动脉压。术中采用四肢覆盖棉垫、手术床铺电温毯、加温输注液体、温盐水冲洗腹腔等措施，维持患者体温。麻醉后将温度探头置入患者食管连续监测食管温度。结果? 食管温度无肝期30 min和新肝期30 min与切皮前即刻比较，差异有非常显著性（P＜0.01）。术中发生体温过低（低于36.0 ℃）12例（80%），1例最低体温为33.3 ℃，发生在新肝早期。发生室性早搏3例，1例发生室性早搏时体温过低（33.5 ℃），经处理后恢复正常，无心跳骤停发生。结论? 经典非转流肝移植术中患者极易发生体温过低，以无肝晚期及新肝早期体温最低，体温保护措施可减少体温过低的发生率、减轻发生低体温的程度。 　　［关键词］? 肝移植术；体温；护理 　??? Effect of classics unturn-.flowing in body temperature of patient during orthotopic liver transplantation ??? ［Abstract］? Objective? To observe the effects of classics unturn-.flowing in body temperature of patient during orthotopic liver transplantation and to provide the basis for strengthening care in temperature of patient.Methods? ASA Ⅲ or Ⅴ grade fifteen patients undergone orthotopic liver transplantation.After anesthesia induced,cardiac output,mixd venous oxygen saturation and central venous temperature were continuously monitored during operation.ECG,CVP,SpO2,PETCO2,radial artery and MPAP were also continuously monitored during operation.Arms and legs were covered cotton cushion in the operation.Bed of operation was extended electric hot carpet in the operation.For protection body temperature,liquid of injection was being heated and warm salt-.water washed abdominal cavity.Body temperature apparatus of the installing esophagus monitored simultaneously temperature of the esophagus.Results? Esophagus temperature were more higher in 30 min after liver removed and in 30 min after reperfusion of the graft than that of before skin incision in 30 min (P＜0.01).There are 12 cases in lower temperature.There is a case in lowest temperature during early time after reperfusion of the graft.Three cases took place ventricular early beat rhythmically.A case occurred ventricular early beat rhythmically in much lower temperature.No one ha