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：

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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.	张瀚之, 陈哲宇, 严律南, 等. 肝包虫病外科治疗的单中心经验. 中国普外基础与临床杂志, 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.	中国医师协会外科医师分会包虫病外科专业委员会. 肝两型包虫病诊断与治疗专家共识 (2015 版) 中华消化外科杂志, 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.	杨先伟, 黄斌, 邱逸闻, 等. 离体肝切除联合自体肝移植治疗晚期肝泡型包虫病 21 例报道. 中国普外基础与临床杂志, 2017, 24(6): 685-690.
6.	王文涛, 杨先伟, 严律南. 离体肝切除联合自体肝移植治疗晚期肝泡型包虫病. 中国普外基础与临床杂志, 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.	孙同文, 吴琼, 阚全程, 等. 高钠血症对重症监护病房患者预后影响的荟萃分析. 中华危重病急救医学, 2014, 26(4): 228-232.
11.	董兰, 安丽娜, 岳阳, 等. 肺保护性通气对肝移植术后患者急性肺损伤的影响. 中华麻醉学杂志, 2017, 37(4): 404-407.
12.	Błaszczyk 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, 陈绍洋, 王强, 等. 肝移植术麻醉中自体血液回输技术的应用. 临床麻醉学杂志, 2009, 25(2): 127-129.
14.	魏昌伟, 倪新莉. 肝移植患者围术期血液保护研究进展. 临床麻醉学杂志, 2013, 29(8): 815-817.
15.	姜华, 张欢. 肝移植术患者术中大量输血的危险因素分析. 临床麻醉学杂志, 2011, 27(3): 213-215.
16.	王伟, 叶啟发, 范晓礼, 等. 自体肝移植术中静脉转流技术的探讨. 中华肝胆外科杂志, 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, Cerviño G, et al. Hyperkalaemia and massive haemorrhage in liver transplantation. Colombian J Anesthesiol, 2014, 42(3): 214-219.
19.	朱伟, 朱敏敏, 田伟千, 等. 原位肝移植围术期血液酸碱和电解质变化. 临床麻醉学杂志, 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, 王莹恬, 等. 非转流经典原位肝移植病人术中血糖和乳酸的变化. 中华麻醉学杂志, 2004, 24(5): 328-331.
22.	关健强, 蔡珺, 高婉菱, 等. 原位肝移植术中血糖和乳酸的变化. 实用医学杂志, 2007, 23(16): 2467-2469.

1. 张瀚之, 陈哲宇, 严律南, 等. 肝包虫病外科治疗的单中心经验. 中国普外基础与临床杂志, 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. 中国医师协会外科医师分会包虫病外科专业委员会. 肝两型包虫病诊断与治疗专家共识 (2015 版) 中华消化外科杂志, 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. 杨先伟, 黄斌, 邱逸闻, 等. 离体肝切除联合自体肝移植治疗晚期肝泡型包虫病 21 例报道. 中国普外基础与临床杂志, 2017, 24(6): 685-690.
6. 王文涛, 杨先伟, 严律南. 离体肝切除联合自体肝移植治疗晚期肝泡型包虫病. 中国普外基础与临床杂志, 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. 孙同文, 吴琼, 阚全程, 等. 高钠血症对重症监护病房患者预后影响的荟萃分析. 中华危重病急救医学, 2014, 26(4): 228-232.
11. 董兰, 安丽娜, 岳阳, 等. 肺保护性通气对肝移植术后患者急性肺损伤的影响. 中华麻醉学杂志, 2017, 37(4): 404-407.
12. Błaszczyk 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, 陈绍洋, 王强, 等. 肝移植术麻醉中自体血液回输技术的应用. 临床麻醉学杂志, 2009, 25(2): 127-129.
14. 魏昌伟, 倪新莉. 肝移植患者围术期血液保护研究进展. 临床麻醉学杂志, 2013, 29(8): 815-817.
15. 姜华, 张欢. 肝移植术患者术中大量输血的危险因素分析. 临床麻醉学杂志, 2011, 27(3): 213-215.
16. 王伟, 叶啟发, 范晓礼, 等. 自体肝移植术中静脉转流技术的探讨. 中华肝胆外科杂志, 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, Cerviño G, et al. Hyperkalaemia and massive haemorrhage in liver transplantation. Colombian J Anesthesiol, 2014, 42(3): 214-219.
19. 朱伟, 朱敏敏, 田伟千, 等. 原位肝移植围术期血液酸碱和电解质变化. 临床麻醉学杂志, 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, 王莹恬, 等. 非转流经典原位肝移植病人术中血糖和乳酸的变化. 中华麻醉学杂志, 2004, 24(5): 328-331.
22. 关健强, 蔡珺, 高婉菱, 等. 原位肝移植术中血糖和乳酸的变化. 实用医学杂志, 2007, 23(16): 2467-2469.

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

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