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首页> 外文期刊>Journal of Clinical Monitoring and Computing >Transjugular intrahepatic portosystemic shunt (TIPS): the anesthesiological point of view after 150 procedures managed under total intravenous anesthesia
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Transjugular intrahepatic portosystemic shunt (TIPS): the anesthesiological point of view after 150 procedures managed under total intravenous anesthesia

机译：经颈静脉肝内门体分流术（TIPS）：在完全静脉麻醉下进行150例手术后的麻醉学观点

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摘要

TIPS is a percutaneous procedure which diverts blood from the portal to the systemic circulation preventing rebleeding from varices and stopping or reducing the formation of ascites. The choice of the anaesthetic technique is still a matter of debate. Since January 2003, 150 consecutive TIPS were performed using total intravenous anesthesia (TIVA), (propofol/fentanyl or remifentanil), endotracheal intubation and mechanical ventilation. Sixty-one patients were classified as ASA 2, 73 ASA 3, and 16 ASA 4. According to CHILD classification, 96 patients were in Class A, 48 in Class B, 6 in Class C. Mean duration f the procedure was 100±62 min. After TIPS placement Portal vein pressure decreased from 30±10 to 14±4 mmHg while RAP increased from 8±4 to 12±6 mmHg. Intraoperative fluid management included mainly crystalloids (750±200 ml, 5.4±1.5 ml/kg/h). Fresh frozen plasma (median 2 units, range 1–3) was given in 20 patients (13%) if PT INR was >2. Packed red cells (median 2 units, range 1–5) were transfused in 35 patients (23%) to keep haematocrit >25%; platelets were administered before the procedure if platelet count was <50,000×10?9 (20 patients, 13%). Urine output was kept above 4 ml/kg/h with loops diuretics (mean diuresis 700±200 ml, 5±1.5 ml/kg/h). Ten patients (6.6%) required ICU after the procedure, because of intraoperative hemodynamic instability. Three patients (2%) died in the early postoperative period because of multiple organ failure associated with the acute deterioration of an already marginal hepatic function.
机译：TIPS是一种经皮手术，可将血液从门静脉转移到全身循环，防止静脉曲张再出血，并阻止或减少腹水的形成。麻醉技术的选择仍是一个争论的问题。自2003年1月以来，使用全静脉麻醉（TIVA），（异丙酚/芬太尼或瑞芬太尼），气管插管和机械通气进行了150次连续TIPS。 61名患者被分类为ASA 2、73 ASA 3和16 ASA4。根据CHILD分类，A级96例，B级48例，C级6例。平均手术时间为100±62分钟放置TIPS后，门静脉压力从30±10毫米汞柱降低到14±4 mmHg，而RAP从8±4毫米汞柱升高到12±6 mmHg。术中液体管理主要包括晶体（750±200 ml，5.4±1.5 ml / kg / h）。如果PT INR> 2，则对20例患者（13％）给予新鲜冷冻血浆（中位2个单位，范围1-3）。在35例患者（23％）中输注了堆积的红细胞（中位2个单位，范围1-5），以使血细胞比容保持> 25％。如果血小板计数<50,000×10？9 ，则在手术前先进行血小板治疗（20例患者，占13％）。用loop利尿剂将尿量保持在4 ml / kg / h以上（平均利尿剂700±200 ml，5±1.5 ml / kg / h）。由于术中血流动力学不稳定，术后有10例患者（6.6％）需要加护病房。三名患者（2％）在术后早期因多器官功能衰竭与已经边缘肝功能的急性恶化而死亡。

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  • 来源
    《Journal of Clinical Monitoring and Computing》 |2009年第6期|341-346|共6页
  • 作者

    Andrea DeGasperi MD; Andrea Corti MD; Rocco Corso MD; Antonio Rampoldi MD; Elena Roselli MD; Ernestina Mazza MD; Giuliana Fantini MD; Manlio Prosperi MD;

  • 作者单位

    2° Service Anesthesia and Critical Care Medicine Ospedale Niguarda Ca Granda Piazza Ospedale Maggiore 3 20123 Milan Italy;

    2° Service Anesthesia and Critical Care Medicine Ospedale Niguarda Ca Granda Piazza Ospedale Maggiore 3 20123 Milan Italy;

    Department of Interventional Radiology Ospedale Niguarda Ca Granda Milan Italy;

    Department of Interventional Radiology Ospedale Niguarda Ca Granda Milan Italy;

    2° Service Anesthesia and Critical Care Medicine Ospedale Niguarda Ca Granda Piazza Ospedale Maggiore 3 20123 Milan Italy;

    2° Service Anesthesia and Critical Care Medicine Ospedale Niguarda Ca Granda Piazza Ospedale Maggiore 3 20123 Milan Italy;

    2° Service Anesthesia and Critical Care Medicine Ospedale Niguarda Ca Granda Piazza Ospedale Maggiore 3 20123 Milan Italy;

    2° Service Anesthesia and Critical Care Medicine Ospedale Niguarda Ca Granda Piazza Ospedale Maggiore 3 20123 Milan Italy;

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  • 正文语种 eng
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  • 关键词

    Anesthesia; general; Total intravenous anesthesia; TIPS; Fluid management;

    机译：麻醉;全身;全静脉麻醉;TIPS;流体处理;

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