| Objective:To investigate the clinical efficacy and application value of alprostadil in orthotopic liver transplantation by comparing the difference in pulmonary artery pressure(PAP)and hemodynamics between patients who continuously used low-dose alprostadil(1.5ng/kg·min)and patients who did not use it in orthotopic liver transplantation.And analyze the factors that may affect PAP in the new liver stage to guide intraoperative anesthesia management and promote the early recovery of patients.Methods:Twenty-two patients who received orthotopic liver transplantation from March 2018 to September 2019 in our hospital were randomly divided into an experimental group(12 cases)and a control group(10 cases).After induction of anesthesia,a floating catheter sheath and a central venous catheter ware placed through the right internal jugular vein.And then a floating catheter was placed through the floating catheter sheath to continuously monitor mean pulmonary arterial pressure(MPAP),continuous cardiac output(CCO)and central venous pressure(CVP).The experimental group was continuously pumped with alprostadil(1.5ng/kg·min)via a micropump,and the control group was continuously pumped with the same amount of saline through a micropump.Finally,separately recorded the changes in PAP,CCO,CVP,heart rate(HR),and mean arterial pressure(MAP)at immediately placing the floating catheter(T1),15minutes before blocking(T2),15minutes after blocking(T3),15minutes before opening(T4),15minutes after opening(T5),2 hours during the new liver period(T6),and abdominal closure(T7)(Note:All the blocking and opening in this article refer to blocking and opening portal vein and inferior vena cava).Results:The hemodynamics and MPAP of the two groups had the same dramatic changes after blocking and opening the portal vein and the inferior vena cava(P<0.05).After blocking the portal vein and the inferior vena cava in anhepatic phase,a large amount of venous blood accumulated in the lower body,and the return blood dropped sharply,resulting in the decrease of CCO,CVP,MPAP,and the compensatory increase of HR(P<0.05).On the contrary,after opening the portal vein and inferior vena cava in the early stage of the new liver,a large amount of venous blood accumulating in the lower body returned,resulting in a sudden increase of return blood volume.In addition,due to reperfusion injury,circulation overload and other reasons,CCO,CVP and MPAP increased,but the HR slowed down reflexively(P<0.05).However,at different times of the surgery,there was no statistically significant difference in MPAP,CCO,MAP,HR,and CVP between the two groups(P>0.05).Similarly,there was no significant difference between the two groups in basic information(age,gender,height,weight,ASA classification)and basic information in liver transplantation(infusion,concentrated red blood cell concentrate infusion,plasma infusion,blood loss,urine,operation time and anhepatic period time)(P>0.05),and the difference in hemodynamics and MPAP changes between the two groups at T7 and T1 was not significant(P>0.05).Conclusion(s):In orthotopic liver transplantation,the patient's hemodynamic changes were significant after blocking and opening the inferior vena cava and portal vein.And continuous pumping of low-dose alprostadil(1.5ng/kg·min)had little effect on the PAP and hemodynamics.Therefore,we still need to invest a lot of work and carry out more in-depth research to mitigate the sharp increase of PAP in the new liver stage,and explore more rapid,accurate,and noninvasive hemodynamic monitoring technology to guide Anesthesia management such as blood transfusion,infusion and the use of vasoactive drugs during the operation to improve the recovery of patients and the success rate of liver transplantation. |
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