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《Chinese Journal of Clinical Rehabilitation》 2005-42
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Relationship between perioperative hemodynamic changes and myocardial damage during orthotopic liver transplantation

Liu De-zhao, Hei Zi-qing, Luo Gang-jian, Li Shang-rong, Ma Wu-hua, Luo Chen-Fang, Department of Anesthesiology, Third Affiliated Hospital, Sun Yat-sen University, Guangzhou 510630, Guangdong Province, China  
AIM: To observe the changes of periopeative hemodynamics and various myocardial enzymes during orthotopic liver transplantation (OLT), and investigate the association between hemodynamics and myocardial damage.METHODS: Twenty patients with end disease of hepatism, whowere selected from the Third Affiliated Hospital of Sun Yat-sen University between June and September 2004, were scheduled for OLT under combined general anesthesia. The hepatic duct, left and right hepatic arteries and portal veins were ligated routinely, the superior and inferior vena cavas were clipped to close from front to behind with the interruption claw of vena cava, supplied liver anastomosis was conducted after diseased liver was cut. The cava was anastomosed firstly, and the stoma was shaped as inverted triangle, and then portal veins were anastomosed, the liver blood supply was recovered to enter the new liver period, and then hepatic arteries and bile duct were anastomosed in order. Blood samples were drawn from central vein at preoperative stage, 30 minutes after anhepatic stage, 30 minutes after reperfusion stage, the end of surgery and 24 hour after operation respectively, the myocardial zymogram was determined, meanwhile, perioperative heart rate, cardiac output, central venous pressure and mean arterial blood pressure were measured. RESULTS: According to intention-to-treat analysis, all the 20 patietns entered the analysis of results. ① Postoperative recovery: All patients received orthotopic liver transplantation successfully. The duration of operation was (335.74±74.04) minutes, and the time of anhepatic phase was (36.37±7.90) minutes. 3 Patients suffered from heart failure among whom 2 died after OLT, the others all recovered very well. ② Changes of hemodynamics: The cardiac output and central venous pressure were decreased at the anhepatic stage (P 0.01) and increased at the reperfusion stage (P 0.01 or P 0.05). The mean arterial blood pressure once decreased while blocking and opening the inferior vena cave, but it could keep stable after applying some vasoactive drugs. Heart rate increased while entering the anhepatic stage, when it came into the reperfusion stage, heart rate increased in the early period and rebounded to the preoperative level. ③Changes of myocardial zymogram: Compared with the preoperative stage: Only myohaemoglobin was significantly increased (P 0.01) at 30 minutes after anhepatic stage, and others had no significant differences (P 0.05) At 30 minutes after reperfusion and the end of the surgery, all of the values of myocardial zymogram were significant increased And at the phase of 24 hour after operation, all the values increased significantly (P 0.05 or 0.01) except that lactate dehydrogenase isoenzyme had no obvious changes (P 0.05). Compared with the stage of 30 minutes after reperfusion, aspartate aminotransferase, lactate dehydrogenase, lactate dehydrogenase isoenzyme and alpha-hydroxybutyrate dehydrogenase at 24 hour after operation were significantly decreased (P 0.05), and creatine kinase was significantly increased (P 0.05), and isoenzyme of creatine kinase and myohaemoglobin had no significant differences (P 0.05). CONCLUSION: After reperfusion high hemodynamics occurred and myocardial zymogram increased generally, and myocardial zymogram recovered at 24 hours after OLT, which indicated that there is divergence phenomenon between hemodynamics and myocardial zymogram.
【Fund】: 国家自然科学基金资助项目(30271254);; 广东省科技计划项目(2004B35001005)~~
【CateGory Index】: R657.3
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