课题背景：广西科学基金包括广西自然科学基金、广西青年科学基金及广西留学回国人员科学基金。课题利用漂浮导管监测猪肝移植术中血流动力学及心肌肌钙蛋白的变化，以期找出此手术方式对血流动力学和心肌损害的影响，为指导临床上麻醉的安全应用以及评价心肌保护效果提供理论依据。

应用要点：文章通过为肝移植患者放置漂浮导管，对肝移植术中各阶段的中心静脉压、肺动脉压、肺毛细血管楔压实行监测，观察其各阶段变化情况，为手术的容量管理提供了依据，可以最大限度地减少肺损伤及术后并发症，有利于提高肝移植患者存活率。

同行评价：肝移植是目前治疗多种原因所致终末期肝病的最有效办法。肝移植患者围麻醉期病理生理变化复杂，尤以无肝期和新肝早期的血流动力学、再灌注综合征、电解质和酸碱平衡及凝血功能等变化最为突出。心率在无肝期和新肝早期显著增加，平均动脉压、中心静脉压、肺动脉压在无肝期明显减低，新肝期均恢复至无肝前期水平，术中应密切监测各项指标以指导术中麻醉管理。

摘要
目的: 原位肝移植围术期维持血流动力学平稳是手术成功的基本保证，通过置入漂浮导管检测改良背驮式肝移植患者围手术期的中心静脉压、肺动脉压、肺毛细血管楔压变化，以减少肺损伤及术后并发症。
方法：①实验对象：选择 2004-02 /2007-08于广西壮族自治区人民医院行肝移植手术的终末期肝病患者6例。②实验方法：入室后行桡动脉穿刺监测平均动脉压、心率，并行血氧饱和度及心电图监护，采用气管内静吸复合全麻。术中吸入异氟醚和间断静脉注射芬太尼+维库溴铵维持麻醉，选择经右侧颈内静脉置入Swan-Ganz漂浮导管。③实验评估：右心置入导管后监测术前、无肝前5 min、无肝即时、无肝10 min、无肝30 min、新肝即时、新肝5 min、新肝30 min时中心静脉压、肺动脉压、肺毛细血管楔压。
结果：6例患者全部进入结果分析。与术前相比，6例患者在无肝即时中心静脉压下降（Q=3.64，P < 0.05）；在新肝即时，肺动脉压升高（Q=4.30，P < 0.05），肺毛细血管楔压升高（Q=5.34，P < 0.01）。
结论：肝移植围术期中心静脉压、肺动脉压、肺毛细血管楔压的变化通过置入Swan-Ganz导管加强监测，可以及时调控得到基本纠正。
关键词：肝移植；导管插入术；麻醉

秦丹丹，梁宁，张庆敏，黄中华.改良背驮式肝移植术中应用Swan-Ganz漂浮导管的意义[J].中国组织工程研究与临床康复，2008，12(5):827-830 [www.zglckf.com/zglckf/ejournal/upfiles/08-5/5k-827(ps).pdf]

Usefulness of Swan-Ganz catheter in modified piggyback liver transplantation

Abstract

AIM：To sustain stable haemodynamics is important for a success surgery during perioperative period of orthotopic liver transplantation. In order to reduce the lung injury and postoperative complications, the Swan-Ganz floating tube was catheterized to investigate the changes in central venous pressure (CVP), pulmonary artery pressure (PAP) and pulmonary capillary wedge pressure (PCWP) during perioperative period of modified piggyback liver transplantation.
METHODS: ①Six patients with end-stage liver disease underwent liver transplantation at the People's Hospital of Guangxi Zhuang Autonomous Region from February 2004 to August 2007. ②Mean arterial pressure (MAP) and heart rate were measured by radial artery puncture, and blood oxygen saturation and electrocardiogram were supervised by Swan-Ganz floating tube catheterized through right intermal jugular vein. Anesthesia was induced with isoflurane inhalation and fentanyl plus vecuronium bromide by discontinuously vein injection. ③ CVP, PAP and PCWP were observed at pre-operation(T1), 5 minutes before anhepatic phase(T2), anhepatic phase(T3), 10 minutes after anhepatic phase(T4), 30 minutes after anhepatic phase(T5), neohepatic phase(T6), 5 minutes after neohepatic phase(T7) and 30 minutes after neohepatic phase(T8).
RESULTS: Six patients were included in the final analysis. At anhepatic phase, CVP was decreased significantly compared to those before the surgery（Q=3.64, P < 0.05）. PAP was increased significantly compared to those before the surgery（Q=4.30, P < 0.05）. PCWP was increased significantly compared to those before the surgery（Q=5.34, P < 0.01）.
CONCLUSION: Comprehensive treatment, timely management and the use of Swan-Ganz tube may check the changes in CVP, PAP and PCWP during liver transplantation.

Qin DD, Liang N, Zhang QM, Huang ZH.Usefulness of Swan-Ganz catheter in modified piggyback liver transplantation.Zhongguo Zuzhi Gongcheng Yanjiu yu Linchuang Kangfu 2008;12(5):827-830(China)
[www.zglckf.com/zglckf/ejournal/upfiles/08-5/5k-827(ps).pdf]