Application of gastrointestinal mucosa pH monitoring during orthotopic liver transplantation

Objective To assess the clinical value of gastric intramucosal pH(pHi)monitoring during orthotopic liver transplantation.Methods Thirty patients undergoing orthotopic liver transplantation were included in this study.mean artery pressure(MAP),pulmonary capillary wedge pressure(PCWP),cardiac index(CI),heart rate(HR),Central venous pressure(CVP)pHi,Pg-PaCO2 and anerial pH were measured at time-points of pre-operation(T0),30 min before anhepatic phase(T1),5 min(T2)and 30 min (T3)of anhepatic phase,5 min(T4),30 min(T5)and 60 rain(T6)after reperfusion of the transplanted liver and at the end of operation(T7).Results MAP,pHi,pHa decreased and PCO2 gap,HR increased at T2 to T5(P<0.05),and pHi reduced to the lowest level at T4.CVP,PCWP and CI significantly decreased at T2,T3 and obviously increased at T4,T5(P<0.05～0.01).All the indexs at T7 recovered to the level of pre-operation(T0). Conclusion Hemodynamics fluctuates greatly during orthotopic liver transplantation.Significant decrease in pHi indicates gastrointestinal mucosa hypoperfusion,ischemia and hypoxia,and gastrointestinal mucosa pH is a sensitive monitoring item for early detection of gastrointestinal mucosa ischemia and hypoxia. Key words: orthotopic liver transplantation; gastrointestinal mucosa pH monitoring