Một số đặc điểm lâm sàng, cận lâm sàng trong gây mê hồi sức bệnh nhân ghép gan từ người cho sống tại Bệnh viện Trung ương Quân đội 108

Abstract

Objective: To review on some features of anesthesia in liver transplant patients from living donors at 108 Military Central Hospital. Subject and method: A prospective, descriptive study on 82 patients divided into 2 groups, group of liver transplant surgery due to liver cancer (group U) and group of liver transplant due to cirrhosis, end stage liver failure (group XS). The patient received balance anesthesia with anesthesia machine AiSys CS2, maintain with desflurane, fentanyl, and esmeron, target of BIS 40-60, TOF 0, hemodynamic management with the support of volumview system, blood gas test, biochemistry, hematology, ROTEM coagulation every 30-60 minutes. The goal of maintaining Hct are 25-28%; Platelets > 30G/l, Fib > 0.8g/l; INR < 2, glucose < 10mmol, albumin > 30g/l. Result: Both groups were mainly men, in which the liver tumor group had 29/30 patients (96.6%), the XS group had 44/53 patients (84.6%). In the group of liver tumors, most of the clinical and paraclinical indicators were within normal limits or mild disturbances, MELD score < 25. XS group were mostly severe and very severe patients: 21 patients had MELD index Score 40, 21 patients in hepatic encephalopathy in which there were 9 patients with grade III and IV coma (17.3%), 26 patients with moderate and severe pleural and peritoneal effusion (50%), 07 patients with prior mechanical ventilation. After surgery (13.5%), 86.5% had moderate-severe coagulopathy. Reperfusion syndrome was seen in 76.6% of liver tumors, 49/52 patients in XS group (94.2%), 100% needed to supplement with fresh frozen plasma (FFP) and Albumin during surgery. 100% of patients in group XS needed infusion red pack cell (RPC) with an average volume of 1816ml. Patients who met the criteria for extubation immediately after surgery in the liver tumor group were 100%, the cirrhosis and liver failure groups were 59.6%. No death in the operating room. Conclusion: Severe disorders as a result of end-stage hepatobiliary disease were found at a high rate in the group of patients with liver failure and cirrhosis. During surgery, most of them had reperfusion syndrome, hemodynamic disorders, and needed vasopressor support. The liver tumor group is less disordered and has a better prognosis in anesthesia resuscitation. Immediately after surgery, early extubation can still be considered for eligible patients.