RESUMEN
Objective To investigate the risk factors of developing cardiac arrest in postreperfusion syndrome ( PRS) of orthotopic liver transplantation ( OLT ).Methods Clinical data of 192 patients who underwent OLT in the Third Hospital of Hebei Medical University from 2003 to 2013 were retrospectively analyzed.Among them, 38 patients developed PRS.According to the occurrence of cardiac arrest or not , the patients were divided into 2 groups, including 7 cases in cardiac arrest group (5 males and 2 females) and 31 cases in non-cardiac arrest group (23 males and 8 females).The probable influence factors of cardiac arrest were selected, including gender, age, preoperative cardiac indexes ( electrocardiogram or color doppler ultrasound of heart ) , preoperative albumin , borderline pH value during opening circulation , borderline temperature, borderline blood potassium level , blood calcium level after opening , degree of donor fatty liver , time of occluding inferior vena cava , and cold ischemia time of donor liver.Comparison of data between two groups was used t-test or Fisher exact probability test.Rick factors with significance differences between two groups were analyzed by unconditional Logistic regression analysis.Results Probable risk factors of developing cardiac arrest in PRS included borderline pH value <7.35 during opening circulation , borderline temperature<36 ℃during opening circulation , borderline blood potassium level >4 mmol/L during opening circulation and moderate fatty liver ( all in P<0.05 ).Results of unconditional Logistic regression analysis showed that moderate fatty liver was an independent risk factor of cardiac arrest in PRS.Conclusions Moderate fatty liver is an independent risk factor of cardiac arrest in PRS.The rational application of liver donors and paying more attention to perioperative treatment of recipients have important significance for reducing the incidence of cardiac arrest.
RESUMEN
During orthotopic liver transplantation (OLT), changes of hemodynamic, electrolytes and acid-base balance are frequently occurred. These changes may influence mortality and prognosis during and after surgery. The purpose of this study was to observe and evaluate the changes of hemodynamics and electrolytes occurring in 14 cases canine OLT. After insertion of endotracheal tube, anesthesia was maintained with 1%enflurane and pancuronium bromide. Swan-Ganz catheter(7.5 Fr.) was inserted into right external jugular vein and 20 gauge angiocatheter was also inserted into left femoral artery. Complete hemodynamic variables and electrolytes were measured 30 minutes after skin incision, anhepatic stage, 5 minutes before reperfusion, 5 and 30 minutes after reperfusion. The results were as follows; On reperfusion of grafted liver, 9 cases(64%) showed postreperfusion syndrome. In 9 cases showing Postreperfusion syndrome, cardiac output, systemic vascular resistance, mean pulmonary arterial pressure were decreased and serum potassium concentration was increased on reperfusion, but there were no significant changes in central venous pressure, pulmonary capillary wedge pressure, heart rate, body temperature and serum ionized calcium concentration when comparing with before reperfusion. Decreased mean arterial pressure during reperfusion in postreperfusion syndrome might be speculated through decrease of myocardial contractility and systemic vascular resistance.