中文摘要：

目的分析肝硬化性门肺高压患者肝移植术中体、肺循环血液动力学的变化。方法8例肝硬化性门肺高压患者[平均肺动脉压（MPAP）大于25mmHg]为门肺高压组，年龄50．63岁，体重45—80kg，8例肝硬化未合并门肺高压患者为对照组，年龄32．65岁，体重52—78kg。两组心功能Ⅰ或Ⅱ级，ASAⅡ-Ⅳ级，均接受改良背驮式肝移植术，观察术中体、肺循环血液动力学的变化。结果与对照组比较。门肺高压组术前MPAP、肺循环阻力指数（PVm）升高（P〈0．05）。与术前相比，无肝期两组心脏指数（CI）、MPAP、肺动脉楔压（PAWP）和中心静脉压（CVP）降低，体循环阻力指数（SVRI）升高；新肝期MPAP、CI、CVP升高。门肺高压组新肝期PVRI变化幅度高于对照组（P〈0．05）。结论肝硬化性门肺高压患者新肝期肺动脉压力和肺血管阻力增加更明显。

英文摘要：

Objective To investigate the changes in systemic and pulmonary hemodynamics in patients with liver cirrhosis and portopulmonary hypertension （PPH） during liver transplantation. Methods Eight patients with liver cirrhosis and PPH （5 male, 3 female） aged 50-63 yr weighing 45-80 kg were included in PPH group. Another 8 liver-cirrhotic patients without PPH served as control group. The patients were premedicated with intramuscular phenobarbital 0.1 g and atropine 0.5 rag. Anesthesia was induced with midazolam 3-5 mg, fentanyl 0.15-0.2mg, propofol 1 mg·kg^-1 and veeuronium 0.1 mg· kg^-1 and maintained with 0.5%-3% isoflurane inhalation and intermittent Ⅳ boluses of fentanyl and vecuronium. The patients were mechanically ventilated after tracheal intubation. PETCO2 was maintained at 30-45 mm Hg. Right subclavian vein was eannulated for fluid and drug administration and blood transfusion. Radial artery was eannulated for BP monitoring. Swan-Ganz catheter was placed via right internal jugular vein. BP, CVP, MPAP, PAWP, CI, PVRI and SVRI were monitored and recorded before operation （baseline）, during preunhepatic phase, at 3 and 30 min of anliepatic phase and 3, 7, 15, 60 min of neohepatie phase and at the end of operation. Results （ 1 ） The two groups were comparable with respect to fluid balance, the amount of vasoaetive drugs used during anhepatie and neohepatie phase, duration of anhepatie phase and operation. （2） MPAP and PVRI were significantly higher before operation in PPH group than in control group. （3） CI, MPAP, PAWP and CVP were significantly decreased during anhepatie phase as compared to the baseline values （before operation） in beth groups and then gradually returned to and even exceeded the baseline values during neohepatic phase. （4） During neohepatie phase PVRI in PPH group was significantly increased as compared to the baseline value and was significantly higher than that in control group. Condusion MPAP and PVRI are significantly increased during neohepatic phase in p