Clinical Observation On Changes Of Circulatory System By PICCO Monitoring Technology During Liver Transplantation In Children

Objective:To explore the changes of the circulatory system in children liver transplantation and to understand the characteristics of anesthesia management in children liver transplantation.Methods:A retrospective analysis was performed on 56 children（30 males and 26 females）who underwent liver transplantation in our hospital from July2017 to March 2020.They were 4 months to 10 years old and were ASA grade III to IV.Intraoperatively,the patients were divided into non-picco monitoring group（group A）（24 cases）and PICCO monitoring group（group B）（32cases）.All children were monitored by electrocardiogram（ECG）,pulse oxygen saturation（Sp O2）and noninvasive blood pressure（NIBP）after admission.Midazolam 0.1mg/kg,propofol 2-3mg/kg and fentanyl 2ug/kg were used for anesthesia induction.After the consciousness of the children disappeared,cis atracurium was injected intravenously at 0.2mg/kg.Children without peripheral venous access were induced successively after 6-8%sevoflurane was inhaled and sedated to open peripheral venous access.After anesthesia induction,ultrasound-guided puncture and catheterization of radial artery and internal jugular vein were performed,and femoral artery puncture and catheterization were performed in group B.Intraoperative routine monitoring of non-invasive blood pressure（NIBP）,invasive blood pressure（IBP）,electrocardiogram（ECG）,pulse oxygen saturation（Sp O2）,body temperature（T）,end-expiratory partial carbon dioxide pressure（ETCO2）,central venous pressure（CVP）,and pulse pressure variation rate（PPV）were performed,and patients in group B were given pulse indicating continuous cardiac output monitoring（PICCO）.The age,height,weight,gender,preoperative liver function and other general information of the two groups were collected.The heart rate（HR）,systolic blood pressure（SBP）,diastolic blood pressure（DBP）,central venous pressure（CVP）,PH,residual base（BE）,lactic acid（Lac）,and oxygenation index（OI）of the children were recorded before surgery（T₀）,15min（T₁）before portal vein occlusion,30min（T₂）in the anhepatic phase,1h（T₃）in the neohepatic phase,and at the end of surgery（T₄）.During the operation,dim sum output（CO）,cardiac index（CI）,total end-diastolic volume index（GEDVI）,stroke volume variation（SVV）and peripheral vascular resistance index（SVRI）were recorded in group B.And record the intraoperative hepatic period length the two groups,the operation time,blood loss,urine volume,red blood cells,plasma into the amount,infusion volume,vascular active drug dosage and cefuroxime Sammy dosage,postoperative mechanical ventilation time and ICU stay time,tracking,and postoperative day 1（T₅）,2（T₆）on the second day,3days（T₇）of HR,SBP,DBP,urine volume,PH value,residual alkali（BE）,lactic acid（Lac）and oxygenation index（OI）.Results:1.There were no statistically significant differences in age,height,weight,gender,operation duration,blood loss,erythrocyte inflow,plasma inflow,vasoactive drugs,furoxime dosage,and preoperative liver function（total bilirubin,albumin,ALT,AST）between the two groups（P>0.05）.The differences in the duration,infusion volume and urine volume of the two groups were statistically significant（P<0.05）,among which,the duration of the liver-free phase in group A was less than that in group B,and the urine volume and infusion volume in group A were greater than that in group B.Both PICU stay time and postoperative mechanical ventilation time in group B were shorter than that in group A,with statistically significant differences（P<0.05）.2.The HR of the two groups was greater in group A than in group B at T0,and the difference was statistically significant（P<0.05）.DBP at T₆ and T₇ was greater in group A than in group B,and the difference was statistically significant（P<0.05）.The difference of SBP at each time point was not statistically significant（P>0.05）.Children’s CVP in the two groups was lower in group A than in group B at T₀,T₂ and T₃,and the difference was statistically significant（P<0.05）.3.In group B,the time point of CO at T₂ was lower than T₀,while the time point of T₄ was greater than T₂,and the difference was statistically significant（P<0.05）.CI was lower than T₀ at T₁,T₂ and T₃,and the difference was statistically significant（P<0.05）.GEDVI was less than T₀ at time T₂,and the difference was statistically significant（P<0.05）.SVRI was higher at time T₂ than at other time points,and the difference was statistically significant（P<0.05）.At time point T₄,SVV was smaller than time point T₂,and the difference was statistically significant（P<0.05）.4.At the time points of T₀ and T₃,group A was larger than group B,and the difference was statistically significant（P<0.05）.Lac was compared at T₁ and T₅,and the difference was statistically significant（P<0.05）.There was no statistically significant difference between OI and the remaining bases at each time point（P>0.05）.Conclusion:1.Children undergoing liver transplantation were in a state of high dynamic circulation before operation;2.In the liver-free stage,CO,CI and GEDVI decreased compared with the preoperative level,while SVRI rose to the highest level in the liver-free stage,and all of them were close to the preoperative level at the end of operation;3.The application of PICCO monitoring technology can timely reflect the changes of the circulatory system and volume during the operation of the children.The rational use of vasoactive drugs and precise infusion can help maintain the stability of the circulatory system during the operation and shorten the mechanical ventilation time and PICU residence time after the operation.