Περίληψη:
Studies have stressed the role of adequate tissue oxygenation in the
light of an optimal patient outcome and allograft viability in liver
transplantation. The practice of monitoring conventional hemodynamic
parameters during liver transplantation could be complemented by
parameters assessing real oxygen availability. In the present
prospective study, real arterial available oxygen content (CavlO(2)) and
its extraction ratio (O(2)ERavl) were calculated. These parameters
include the effect of changes in oxyhemoglobin dissociation curve (ODC;
expressed by P-50) on oxygen availability, under the different
circumstances occurring during liver transplantation. Sixteen adult
cirrhotic patients were studied during orthotopic liver transplantation
with the use of venovenous bypass. Classic hemodynamic measurements
using a Swan-Ganz thermodilution catheter and arterial and mixed venous
blood gas analysis were performed, and P-50, oxygen delivery index (DO2
(ind)), oxygen consumption index (VO2ind), oxygen extraction ratio
(O2ER), CavlO(2), and O(2)ERavl were calculated. Statistical analysis
was performed using ANOVA for repeated measures and Spearman correlation
coefficient matrix among the six variables (DO2 (ind), VO2 (ind), O2ER,
P-50, CaV1O(2), and O(2)ERavl) taken two at a time at every phase.
Parameter P-50 changed from 25.98 +/- 1.10 to 23.15 +/- 2.24 (at the end
of operation). A leftward shift of the ODC was observed. The results
showed positive association between P-50 and CavlO(2) after the removal
of the native liver, and a weak and inconsistent relation of DO2 i.d
with any of the other study variables. The intraoperative changes in
P-50 values, which represent a shift of the ODC to the left, may reflect
a more accurate estimation of O-2 release to the tissues, than the
hemoglobin, Pao(2) and SaO(2) alone. Besides conventional hemodynamic
Parameters, P-50 which includes the effect of alterations in ODC on
oxygen availability, could be of value in monitoring the systemic
oxygenation during liver transplantation.
Συγγραφείς:
Kostopanagiotou, G
Smyrniotis, V
Theodoraki, K
Skalkidis, Y
and Heaton, N
Potter, D
