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目的探讨右心室舒张末期容积指数(RVEDVI)监测用于指导合并冠心病患者非转流原位肝移植术中容量管理的可行性。方法术前合并冠心病、行择期原位肝脏移植手术患者2例,通过对RVEDVI和右室射血分数(RVEF)等血流动力学指标的监测,指导2例患者麻醉期间的容量管理。结果 2例肝脏移植患者,术中期严格控制RVEDVI处于90～138ml/m2,根据需要给予多巴胺和去甲肾上腺素维持心输出量(CI)超过2.5L/(min·m2)和平均动脉血压(MAP)超过65mmHg,2例患者围术期均未出现严重心脏并发症,重要器官灌注良好,术后恢复正常出院。结论以RVEDVI为导向容量管理策略,多方面措施联合处理可能是保证合并冠心病患者肝移植手术成功的关键。
Objective To investigate the feasibility of using right ventricular end-diastolic volume index (RVEDVI) to guide volume management in patients with coronary heart disease undergoing orthotopic liver transplantation. Methods Two patients undergoing elective orthotopic liver transplantation undergoing preoperative elective coronary angioplasty were enrolled in this study. The volume management during anesthesia was instructed in 2 patients by monitoring the hemodynamic parameters such as RVEDVI and right ventricular ejection fraction (RVEF). Results Two patients with liver transplantation underwent strict control of RVEDVI between 90 and 138 ml / m2 at the mid-term and dopamine and norepinephrine as needed to maintain cardiac output (CI) over 2.5 L / (min · m2) and mean arterial pressure ) More than 65mmHg, 2 patients did not appear during perioperative complications of severe heart disease, perfusion of vital organs, postoperative recovery to normal discharge. Conclusion RVEDVI-oriented capacity management strategy, multi-measures joint treatment may be the key to ensuring the success of liver transplantation in patients with coronary heart disease.