| Objective: To evaluate the application value of PICCO monitoring in respiratory management of liver transplantation in child under different monitoring methods by retrospective analysis of blood gas analysis and prognosis in intraoperative and postoperative periods.Methods: 37 male and 31 female patients with end-stage liver disease who underwent liver transplantation from July 2017 to April 2020 were selected from the first affiliated hospital of guangxi medical university.There are 37 males and31 females,aged from 4 mouths to 10 years old,with ASA grades III to IV.Patients were divided into PICCO group(group A)and Non-PICCO group(group B)according to different monitoring methods.Routine monitoring(electrocardiogram,pulse oxygen saturation,non-invasive blood pressure,respiration)was performed immediately after the children in the two groups were admitted to the operating room and checked.After anesthesia induction,the radial artery and internal jugular vein puncture and catheterization were performed under the guidance of ultrasound.In group A,patients were performed via femoral artery puncture and catheterization for PICCO monitoring.Intraoperative routine monitoring of electrocardiogram(ECG),pulse oximetry(SPO2),noninvasive and invasive blood pressure(BP),body temperature(T),end-tidal carbon dioxide partial pressure(ETCO2),central venous pressure(CVP),pulse Blood pressure variation rate(PPV),blood gas analysis combined with PICCO monitoring at different periods were to record to understand the lung function and internal environment of the children in intraoperative period,so as to better guide the anesthesia of liver transplantation in children.Record with before the operation(T1),preoperative portal vein blocking anesthesia before 30 minutes(T2),anhepatic period 30 minutes(T3),reperfusion period 30 minutes(T4),reperfusion period 1 hour(T5)and end of the surgery(T6)with heart rate(HR),mean arterial pressure(MAP),PH value,base excess(BE),carbon dioxide partial pressure(PCO2),oxygen partial pressure(PO2),Lac,oxygenation index(PO2 / Fi O2);In addition to the monitoring of the above indicators,the corresponding time point monitoring was performed in group A:cardiac index(CI),systemic vascular resistance index(SVRI),cardiac output(CO),intrathoracic blood volume index(ITBVI),extravascular lung water index(EVLWI)and pulmonary vascular permeability index(PVPI).The patient’s personal information,preoperative liver function,intraoperative fluid intake,blood product input,postoperative ICU stay,mechanical ventilation time.PH,BE,PCO2,PO2,Lac,and PO2/Fi O2 on day 1(T7),day 2(T8),and day 3(T9)after surgery were collected.Results:(1)There were no statistically significant differences in gender,age,height,weight,duration of surgery,duration of anesthesia,red blood cell input,plasma input,blood loss,furosemide dosage,norepinephrine dosage,preoperative liver function(total bilirubin,AST,ALT,albumin)between groups A and B(P>0.05).(2)Intraoperative infusion volume and urine volume in group A were significantly reduced compared with group B,postoperative mechanical ventilation time and PICU residence time were significantly shortened than group B,the time of anthepatic phase was longer than that of Group B,with statistically significant differences(All P <0.05).(3)Intraoperative comparison of HR and MAP in two groups at different time points: there were no statistically significant differences at each time point(P > 0.05).Intra-group comparison: there was no statistical difference between HR groups at each time point(P > 0.05).The MAP of T4 and T5 in group A was lower than T3,and the MAP of T5 in group B was lower than T3,showing statistical difference(P<0.05),while the MAP of the remaining time points showed no statistical difference(P > 0.05).(4)Comparison between intraoperative and postoperative blood gas analysis groups: PH in T1,T4 and T6 groups were significantly different,all of which were higher in Group B than in group A(P <0.05).Lac of T3 in group B was greater than that of Group A(P <0.05).There were no statistically significant differences in PH,Lac,BE,Pa CO2 and Pa O2/Fi O2 between the remaining time points(P > 0.05).Intra-group comparison: PH:Comparison of T4,T5 and T9 with T1,Comparison of T4,T5,T8 and T9 with T2,comparison of T5-T9 with T4,comparison of T6-T9 with T5,comparison of T8,T9 with T6 and T7,all P <0.05.In group B,comparison of T2,T4 and T5 with T1,T3 and T8 with T2,T4 and T5 with T3,All P <0.05.BE: Comparing T2-T4 with T1 and T6 in group A,P <0.05.Comparison of T1,T3,T5 and T6 with T4 in Group B;comparison of T2 and T1 with P <0.05.Comparison of T8 and T7 in group A and T9 and T7 in group B showed P <0.05.Compared between T7 ~ T9 and T1 ~ T6 in group A and B,P <0.05.Pa CO2: In group A,T2 and T3 were compared with T1,T3 and T6 were compared with T2,And T4 ~ T6 were compared with T3,all P<0.05.Comparison of T1,T3 and T4 with T5 and T6 and Comparison of T2 and T3 in Group B all P <0.05.Compared between T7 ~ T9 and T1 ~ T6 in group A and B,P <0.05.Pa O2/Fi O2: The Pa O2/Fi O2 of T1 in both groups was the lowest,T2~T6 was significantly higher than T1,T4 was higher than T5,and the difference was statistically significant(P <0.05).The Pa O2/Fi O2 in T7~T9 was compared with that in T1 ~ T6 except for T7 and T9 in Group A,P <0.05.Lac: T1 was the lowest in both groups A and B during operation,while T4 was the highest.T1 was significantly lower than T2~T6,P <0.05.T3~T5 was higher than T2 in group A and Group B(P <0.05).Comparing T4 and T3,P <0.05;Lac in T7~T9was compared with that in T1 ~ T6 except T7 in group A,P <0.05.(5)There was no significant difference in pulmonary ventilation index between the two groups(P >0.05).Intra-group comparison: Pa O2/Fi O2 comparison was the same as before;P(A-a)O2 was the highest in T1 between the two groups,which was statistically different from T2~T6(P <0.05),while T5 was higher than T4 in Group A(P <0.05).P(a-v)O2 in T1 and T6 was lower than that in T3,and the difference was statistically significant(P <0.05).There was no statistically significant difference in the intra-group comparison of the three indicators at the remaining time point(P >0.05).(6)intra-group comparison of PICCO monitoring indicators in group A: EVLWI in T2~T6 was higher than that in T1,but there was no statistical difference in comparison at each time point(P >0.05).The PVPI of T3~T5 was higher than that of T1,with statistically significant difference(P <0.05).ITBVI of T2~T5 was lower than that of T1,and the difference was statistically significant(P <0.05).CI and CO in T1,T4 and T6 were all higher than T3,with statistically significant differences(All P <0.05);CO in T2 was lower than T1,with statistically significant differences(P<0.05).SVRI in T1 was significantly higher than that of other times,with statistical differences from T1,T2 and T4~T6(P <0.05).Conclusion: 1.Obvious ventilation pulmonary dysfunction exists in the children underwent liver transplantation.2.Preoperative EVLWI was higher than reference values,and intraoperative EVLWI tended to increase,and the anhepatic phase was higher than the pre anhepatic stage and the reperfusion stage.3.The application of PICCO monitoring technology in children liver transplantation is helpful to reduce intraoperative fluid intake and shorten postoperative mechanical ventilation time and PICU residence time of children. |
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