The Change Of Extravascular Lung Water And Intrathoracic Volume In Living Donor Liver Transplation

Backgrounds and objectives:Many patients of end-stage liver disease had severe pulmonary diseases before liver transplation,for example,hepatopulmonary syndrome. T he pulmonary complications after liver transplation were more than other operations. T he complications were closely related to the pulmonary injury during operations.The overage and too speediness of the fluid leads to pulmonary edema easily.The extravascular lung water(EVLW) rises highly when pulmonary edema happens. Pulmonary edema is an important performance of acute respiratory distress syndrome. The research observed the changes of extravascular lung water(EVLW),intrathoracic volume(ITBV),pulmonary vascular permeability Index(PVPI),systemic vascular resistance(SVR),PaO₂,central venous pressure(CVP),pulmonary artery occlusion pressures(PAOP) and pulse contour cardiac output(PCCO).The objective was to find a new way managing blood volume during perioperative period.Methods:Ten patients of orthotopic living donor liver transplation with no veno-venous bypass were investigated.We Recorded the EVLW,ITBV,PVPI,SVR,PaO₂,CVP,PAOP and PCCO of half-hour after anaesthetic induction(T₁),half-hour before blockage of portal vein(T₂ ),fifteen minutes after blockage of portal vein(T₃ ),fifteen minutes before opening of portal vein(T₄ ),half-hour after opening of portal vein(T₅ ). Results:The ITBV in T₃,T₄ and T₅ were fewer than T₁ and T₂(P<0.01),T₃ and T₄ were fewer than T₅(P<0.05).The SVR in T₃ and T₄ were more than T₁,T₅ and T₂(P< 0.01).The EVLW in T₃ and T₅ were fewer than T₄(P<0.01).The PVPI in T₃ and T₄ were more than T₁ and T₅(P<0.05),T₄ was more than T₂(P<0.05).The PaO₂ in T₃ and T₄ were fewer than T₅(P<0.05).There was no difference in each two time points of CVP.The PAOP in T₃ and T₄ were fewer than T₁ and T₂(P<0.01).The PCCO in T₃ and T₄ were fewer than T₁,T₂ and T₅(P<0.01).Conclusions:The intrathoracic volume(ITBV) is a preferable indicator for Monitoring cardiac preload in patients with living donor liver transplation.The EVLW and the PVPI is a sensitive index for pulmonary injury in patients with living donor liver transplation.