Abstract：
Transpulmonary thermodilution is often used to measure extravascular lung water during liver transplantation. Here, the case of new onset atrial fibrillation during orthotopic liver transplantation, which may have been induced by iced saline injection for transpulmonary thermodilution measurement, is described. A 52-year-old male patient underwent orthotopic liver transplantation due to alcoholic cirrhosis combined with portal hypertension. During dissection of the recipient liver, transpulmonary thermodilution was performed. At 3 minutes following iced saline injected, atrial fibrillation occurred, the ventricular rate increased to more than 120 beats per min, and blood pressure dropped to 75/50 mmHg. Massive haemorrhage, inferior vena cava clamping, electrolyte disorder, acid-base balance disorder, and hypothermia were all ruled out, and iced saline injection was suspended. Hemodynamic stability was maintained with phenylephrine and lanatocide C (cedilanid), and chemical cardioversion was performed using amiodarone. During the reperfusion phase, transient hemodynamic instability was managed by norepinephrine. The neohepatic phase was uneventful. Atrial fibrillation lasted for 5 days and reversed to sinus rhythm automatically. The patient was hemodynamically stable during this period, and recovery was smooth with no thromboembolic events. In conclusion, atrial fibrillation may be induced by iced saline injection for transpulmonary thermodilution measurement during orthotopic liver transplantation.
摘要：
经肺热稀释法通常用于测量肝移植期间的血管外肺水。这里,原位肝移植期间新发房颤的病例，这可能是通过注射冰盐水进行经肺热稀释测量引起的，被描述。一名52岁的男性患者因酒精性肝硬化合并门静脉高压症接受了原位肝移植。在解剖受体肝脏的过程中，进行经肺热稀释。注射冰盐水后3分钟，发生心房颤动,心室率增加到每分钟120次以上，血压降至75/50mmHg。大量出血，下腔静脉夹闭,电解质紊乱，酸碱平衡紊乱,体温过低都被排除了,并暂停注射冰盐水。用去氧肾上腺素和杀羊剂C（西地兰）维持血流动力学稳定性，使用胺碘酮进行化学复律。在再灌注阶段,短暂性血流动力学不稳定由去甲肾上腺素控制.新肝期是平静的。心房颤动持续5天，并自动逆转为窦性心律。患者在此期间血流动力学稳定，恢复顺利,无血栓栓塞事件.总之,在原位肝移植过程中，注射冰盐水进行经肺热稀释测量可能会引起心房颤动。
