Parameters monitoring of mechanics of respiration during perioperative period in patients undergoing orthotopic liver transplantation / 中华器官移植杂志

ABSTRACT

Objective To investigate the changes in mechanics of respiration during perioperative period in patients undergoing orthotopic liver transplantation (OLT) without venovenous bypass. Methods Thirty patients of grade Ⅱ～Ⅲ according to the American Society of Anesthesiologists (ASA) classification, undergoing orthotopic liver transplantation without venovenous bypass, were included in this study. The respiratory parameters measured perioperatively included average airway resistance, peak inspiratory pressure, peak expiratory flow rate, dynamic compliance, work of breathing and respiratory drive. The complications of respiratory system during postoperative period were observed. Results Average airway resistance was decreased after abdominal cavity opening, decreased significantly at 5 min new hepatic phase and increased postoperatively. Peak expiratory flow rate and dynamic compliance were increased gradually after induction and increased significantly at anhepatic phase and new hepatic phase but decreased significantly on the first day postoperatively. Work of breathing was decreased after induction and decreased significantly at anhepatic phase and postoperative period. There was no significant difference in peak inspiratory pressure during operation. Compared with the values preoperation, the respiratory drive was decreased significantly during anhepatic phase and new hepatic phase. Total 35 times of postoperative respiratory complications occurred, which included pleural effusion, atelectasis, pulmonary artery hypertension, pulmonary interstitial edema and pnermonia. Conclusions There are obvious changes in respiratory mechanics during perioperative period of OLT, especially in postoperative period. Mechanical respiratory support is essential for patients until respiratory function recovers.