Research on extubation time and arterial blood gas analysis of <b><i>ex vivo</i></b> liver resection followed by autotransplantation in patients with advanced hepatic alveolar echinococcosis _West China Medical Journal

Authors：

ZHANG Wen ^1,2 , WANG Yangyang ¹ ,  WANG Xiao ¹

1. Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;
2. Department of Anesthesiology, the First People’s Hospital of Chengdu, Chengdu, Sichuan 610016, P. R. China;

Corresponding?author：

WANG Xiao, Email: 1490829116@qq.com

Keywords：

Hepatic alveolar echinococcosis; Ex vivo liver resection; Autotransplantation; Tracheal extubation; Acid-base; Electrolytes

DOI：

10.7507/1002-0179.201712165

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective To explore the correlations between the time of tracheal extubation and the intraoperative basic factors of ex vivo liver resection followed by autotransplantation in patients with advanced hepatic alveolar echinococcosis (HAE), and analyze the change trend of blood gas analysis during operation. Methods The data of 24 patients with advanced HAE who underwent ex vivo liver resection followed by autotransplantation in West China Hospital of Sichuan University between February 2014 and August 2017 were retrospectively analyzed. Results There were significant correlations between the extubation time and the duration of anesthesia (r=0.472, P=0.031), the amount of bleeding (r=0.524, P=0.015), the amount of erythrocyte suspensions infusion (r=0.627, P=0.002), and the amount of plasma infusion (r=0.617, P=0.003). There was no statistical difference in extubation time between patients with and without pulmonary complications in 3 months postoperatively [(23.74±15.84), (15.52±19.40) h, P=0.327]. Compared with those arterial blood gas results before the interruption, the pH value, blood glucose, lactic acid and base excess were statistically significantly different (P<0.05) at each time point after the interruption. Blood potassium increased at the end of operation compared with that before interruption (P<0.05); and the free calcium after blocking and opening increased with a temporary decrease (P<0.05); the hemoglobin decreased significantly after interruption and clamping (P<0.05). Conclusions Anesthesia length and bleeding should be reduced in ex vivo liver resection followed by autotransplantation, thus the extubation time would be shortened and the prognosis of the patients might be improved. Because of the longer anhepatic phase, the blood gas analysis varies largely. During operation, blood gas analysis and monitoring should be strengthened, and the acid-base balance and electrolytes should be maintained in time.

Citation： ZHANG Wen, WANG Yangyang, WANG Xiao. Research on extubation time and arterial blood gas analysis of ex vivo liver resection followed by autotransplantation in patients with advanced hepatic alveolar echinococcosis . West China Medical Journal, 2018, 33(3): 312-316. doi: 10.7507/1002-0179.201712165 Copy

1.	張瀚之, 陳哲宇, 嚴律南, 等. 肝包蟲病外科治療的單中心經驗. 中國普外基礎與臨床雜志, 2015, 22(2): 144-148.
2.	Wen H, Dong JH, Zhang JH, et al. Ex vivo liver resection followed by autotransplantation for end-stage hepatic alveolar echinococcosis. Chin Med J (Engl), 2011, 124(18): 2813-2817.
3.	中國醫師協會外科醫師分會包蟲病外科專業委員會. 肝兩型包蟲病診斷與治療專家共識 (2015 版) 中華消化外科雜志, 2015, 14(4): 253-264.
4.	Hu H, Huang B, Zhao J, et al. Liver autotransplantation and retrohepatic vena cava Reconstruction for alveolar echinococcosis. J Surg Res, 2017, 210: 169-176.
5.	楊先偉, 黃斌, 邱逸聞, 等. 離體肝切除聯合自體肝移植治療晚期肝泡型包蟲病 21 例報道. 中國普外基礎與臨床雜志, 2017, 24(6): 685-690.
6.	王文濤, 楊先偉, 嚴律南. 離體肝切除聯合自體肝移植治療晚期肝泡型包蟲病. 中國普外基礎與臨床雜志, 2017, 24(7): 792-794.
7.	Jawan B, Chih-Hsien W, Chen CL, et al. Review of anesthesia in liver transplantation. Acta Anaesthesiologica Taiwanica, 2014, 52(4): 185-196.
8.	Glanemann M, Langrehr J, Kaisers U, et al. Postoperative tracheal extubation after orthotopic liver transplantation. Acta Anaesthesiol Scand, 2001, 45(3): 333-339.
9.	Aydin C, Otan E, Akbulut S, et al. Postoperative pulmonary complications after liver transplantation: assessment of risk factors for mortality. Transplant Proc, 2015, 47(5): 1488-1494.
10.	孫同文, 吳瓊, 闞全程, 等. 高鈉血癥對重癥監護病房患者預后影響的薈萃分析. 中華危重病急救醫學, 2014, 26(4): 228-232.
11.	董蘭, 安麗娜, 岳陽, 等. 肺保護性通氣對肝移植術后患者急性肺損傷的影響. 中華麻醉學雜志, 2017, 37(4): 404-407.
12.	B?aszczyk B, Wrońska B, Klukowski M, et al. Factors affecting breathing capacity and early tracheal extubation after liver transplantation: analysis of 506 cases. Transplant Proc, 2016, 48(5): 1692-1696.
13.	曹淑梅, 陳紹洋, 王強, 等. 肝移植術麻醉中自體血液回輸技術的應用. 臨床麻醉學雜志, 2009, 25(2): 127-129.
14.	魏昌偉, 倪新莉. 肝移植患者圍術期血液保護研究進展. 臨床麻醉學雜志, 2013, 29(8): 815-817.
15.	姜華, 張歡. 肝移植術患者術中大量輸血的危險因素分析. 臨床麻醉學雜志, 2011, 27(3): 213-215.
16.	王偉, 葉啟發, 范曉禮, 等. 自體肝移植術中靜脈轉流技術的探討. 中華肝膽外科雜志, 2015, 21(9): 641-644.
17.	Thakrar SV, Melikian CN. Anaesthesia for liver transplantation. Br J Hosp Med, 2017, 78(5): 260-265.
18.	Rando K, Vázquez M, Cervi?o G, et al. Hyperkalaemia and massive haemorrhage in liver transplantation. Colombian J Anesthesiol, 2014, 42(3): 214-219.
19.	朱偉, 朱敏敏, 田偉千, 等. 原位肝移植圍術期血液酸堿和電解質變化. 臨床麻醉學雜志, 2008, 24(8): 670-672.
20.	Shangraw RE. Metabolic issues in liver transplantation. Int Anesthesiol Clin, 2006, 44(3): 1-20.
21.	李士通, 汪正平, 王瑩恬, 等. 非轉流經典原位肝移植病人術中血糖和乳酸的變化. 中華麻醉學雜志, 2004, 24(5): 328-331.
22.	關健強, 蔡珺, 高婉菱, 等. 原位肝移植術中血糖和乳酸的變化. 實用醫學雜志, 2007, 23(16): 2467-2469.

1. 張瀚之, 陳哲宇, 嚴律南, 等. 肝包蟲病外科治療的單中心經驗. 中國普外基礎與臨床雜志, 2015, 22(2): 144-148.
2. Wen H, Dong JH, Zhang JH, et al. Ex vivo liver resection followed by autotransplantation for end-stage hepatic alveolar echinococcosis. Chin Med J (Engl), 2011, 124(18): 2813-2817.
3. 中國醫師協會外科醫師分會包蟲病外科專業委員會. 肝兩型包蟲病診斷與治療專家共識 (2015 版) 中華消化外科雜志, 2015, 14(4): 253-264.
4. Hu H, Huang B, Zhao J, et al. Liver autotransplantation and retrohepatic vena cava Reconstruction for alveolar echinococcosis. J Surg Res, 2017, 210: 169-176.
5. 楊先偉, 黃斌, 邱逸聞, 等. 離體肝切除聯合自體肝移植治療晚期肝泡型包蟲病 21 例報道. 中國普外基礎與臨床雜志, 2017, 24(6): 685-690.
6. 王文濤, 楊先偉, 嚴律南. 離體肝切除聯合自體肝移植治療晚期肝泡型包蟲病. 中國普外基礎與臨床雜志, 2017, 24(7): 792-794.
7. Jawan B, Chih-Hsien W, Chen CL, et al. Review of anesthesia in liver transplantation. Acta Anaesthesiologica Taiwanica, 2014, 52(4): 185-196.
8. Glanemann M, Langrehr J, Kaisers U, et al. Postoperative tracheal extubation after orthotopic liver transplantation. Acta Anaesthesiol Scand, 2001, 45(3): 333-339.
9. Aydin C, Otan E, Akbulut S, et al. Postoperative pulmonary complications after liver transplantation: assessment of risk factors for mortality. Transplant Proc, 2015, 47(5): 1488-1494.
10. 孫同文, 吳瓊, 闞全程, 等. 高鈉血癥對重癥監護病房患者預后影響的薈萃分析. 中華危重病急救醫學, 2014, 26(4): 228-232.
11. 董蘭, 安麗娜, 岳陽, 等. 肺保護性通氣對肝移植術后患者急性肺損傷的影響. 中華麻醉學雜志, 2017, 37(4): 404-407.
12. B?aszczyk B, Wrońska B, Klukowski M, et al. Factors affecting breathing capacity and early tracheal extubation after liver transplantation: analysis of 506 cases. Transplant Proc, 2016, 48(5): 1692-1696.
13. 曹淑梅, 陳紹洋, 王強, 等. 肝移植術麻醉中自體血液回輸技術的應用. 臨床麻醉學雜志, 2009, 25(2): 127-129.
14. 魏昌偉, 倪新莉. 肝移植患者圍術期血液保護研究進展. 臨床麻醉學雜志, 2013, 29(8): 815-817.
15. 姜華, 張歡. 肝移植術患者術中大量輸血的危險因素分析. 臨床麻醉學雜志, 2011, 27(3): 213-215.
16. 王偉, 葉啟發, 范曉禮, 等. 自體肝移植術中靜脈轉流技術的探討. 中華肝膽外科雜志, 2015, 21(9): 641-644.
17. Thakrar SV, Melikian CN. Anaesthesia for liver transplantation. Br J Hosp Med, 2017, 78(5): 260-265.
18. Rando K, Vázquez M, Cervi?o G, et al. Hyperkalaemia and massive haemorrhage in liver transplantation. Colombian J Anesthesiol, 2014, 42(3): 214-219.
19. 朱偉, 朱敏敏, 田偉千, 等. 原位肝移植圍術期血液酸堿和電解質變化. 臨床麻醉學雜志, 2008, 24(8): 670-672.
20. Shangraw RE. Metabolic issues in liver transplantation. Int Anesthesiol Clin, 2006, 44(3): 1-20.
21. 李士通, 汪正平, 王瑩恬, 等. 非轉流經典原位肝移植病人術中血糖和乳酸的變化. 中華麻醉學雜志, 2004, 24(5): 328-331.
22. 關健強, 蔡珺, 高婉菱, 等. 原位肝移植術中血糖和乳酸的變化. 實用醫學雜志, 2007, 23(16): 2467-2469.

Previous Article
Clinical research of 97 cases of donation after citizen death kidney transplantations
Next Article
Investigation on antihypertensive therapy for hypertension patients from plateau area

West China Medical Journal

Research on extubation time and arterial blood gas analysis of ex vivo liver resection followed by autotransplantation in patients with advanced hepatic alveolar echinococcosis

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content