[Significance of hemodynamic changes and monitoring value of patients with severe hepatitis during perioperative orthotopic liver transplantation].

Objective: To observe the hemodynamic changes of the patients with severe hepatitis during orthotopic liver transplantation (OLT).

Methods: Ten patients with severe hepatitis received liver transplantation. The pulmonary artery catheter was inserted into right jugular vein and an arterial line was put in the left radial artery. Hemodynamics parameters including cardiac output (CO), arterial blood pressure (ABP), systemic vascular resistance (SVR), pulmonary vascular resistance (PVR), cardiac index (CI) at different time points were observed.

Results: During the operation, HR was increased, and ABP was significantly decreased at the beginning of anhepatic period and neo-hepatic period. Central venous pressure (CVP) was significantly decreased during anhepatic period and profoundly increased in the early neo-hepatic phase, then declined to normal range progressively. Pulmonary capillary wedge pressure (PCWP) changed in accordance with the variation of pulmonary arterial pressure (PAP). Both of them were significantly decreased during anhepatic period and profoundly increased in the early neo-hepatic phase. SVR was at a lower level before operation, and gradually increased during anhepatic period, then significantly declined at the beginning of anhepatic period. PVR had the most marked changes during the neo-hepatic period, gradually decreased to the pre-operation level after significant elevation at the early neo-hepatic phase. Left ventricular stroke work index (LVSWI) was profoundly declined from the beginning of anhepatic period to the 1 minute after neo-hepatic phase, then progressively increased. Right ventricular stroke work index (RVSWI) was significantly decreased during anhepatic period, then progressively increased during neo-hepatic period. CO and CI maintained at a higher level, significantly declined during anhepatic period compared with pre-anhepatic period and gradually increased to a higher level than peri-operation.

Conclusion: Remarkable changes in hemodynamics of patients with severe hepatitis during liver transplantation are found especially at the early phase of anhepatic and neo-hepatic, while CO maintained at a higher level, together with a complicated changes in SVRI. Monitoring hemodynamics during peri-operation has its value to prevent and manage cardiac insufficiency and low blood volume.