去甲肾上腺素在肝移植麻醉中应用.docVIP

去甲肾上腺素在肝移植麻醉中的应用 王天龙 杨拔贤 中文摘要 肝移植麻醉过程中血管阻力低下常常伴发全身性低血压发生，尽管进行了积极的体液复苏和增加心排出量。如果希望通过恢复动脉血压（80-85mmHg）而旨在保持器官的灌注压，给予血管收缩药如去甲肾上腺素则变得十分必要。然而，因为去甲肾上腺素可诱发许多血管床的血管收缩，它可减少肾和内脏血流，损害内脏器官功能，这种未被证实的恐惧阻止了临床医生更为广泛地使用去甲肾上腺素。在血管舒张状态，并不像正常循环情况，使用去甲肾上腺素可以提高内脏器官血流，并对肾小球滤过率和尿量具有良好效果，同时由于其使用可以避免过度扩容维持血压所引起的脏器功能恢复延迟。肝移植麻醉过程中，血管过度扩张状态时，积极体液治疗后使用去甲肾上腺素具有合理的适应症。 关键词：肝移植，麻醉，内脏，肾脏，去甲肾上腺素，器官血流 Abstract Clinical application of norepinephrine during anesthesia with orthotropic liver transplantation. WANG Tian-long. Department of anesthesia, Peking University People’s Hospital, Beijing，China 100044 The over-decreased vascular resistance was frequently existed with systemic hypotension although the active fluid resuscitation and elevating cardiac output was executed. The administration of vasopressor such as norepinephrine will become necessary if restoring arterial blood pressure (80-85 mmHg) aimed at maintaining the organs perfusion pressure was expected. However, because the norepinephrine infusion might induce lot of vessels-beds vasoconstricted, renal and visceral blood flow decreased, and consequently visceral organs function deteriorated, the un-proved fears were against clinical doctors to broadly use norepinephrine. The norepinephrine infused may increase the visceral-organs blood flow and has excellent effects to glomerular filtration rate (GFR) and urine during the vasodilating status not like normal circulation. At same time, its administration may avoid organs-function recovery retarded due to intravascular over-fluid replacement for gaining adequate blood pressure. The administration of norepinephrine is a reasonable indication while co-existing with vasodilation and after actively replacing intravascular fluid during anesthesia course of orthotropic liver transplantation. [Key Words] liver, transplantation, anesthesia, organ, renal, norepinephrine, blood flow 在过去5年内，肝移植手术作为治疗晚期肝硬化病人的有效方法在中国得以广泛开展。由于传统意识、经济状况以及认识上的差异，绝大多数肝移植的侯选者均选择在肝硬化的晚期接受肝移植手术。晚期肝硬化病人由于其并发的多脏器损害如肝-肾和肝-肺综合症等