肝脏移植术后急性肺损伤患者的临床观察与处理

目的 探讨原位肝移植术后早期发生急性肺损伤的原因及处理方法.方法 以术后早期氧饱和指数低于200作为诊断急性肺损伤的标准.211例患者行原位肝移植术,其中22例死亡,对存活的189例患者术后早期行血气分析及相关检查,分析急性肺损伤与患者原发病以及术中出血量、术后有效循环量的相关性;所有肝移植患者术后均给予氧疗、抗感染、抗排斥反应、保肝、营养代谢支持、利尿与扩血管等综合治疗,根据血气分析及中心静脉压分别调整氧浓度和循环液体量.结果 189例中,146例发生急性肺损伤,占77.5%.经治疗后各脏器功能均恢复正常.发生急性肺损伤与术前肝功能失代偿、术中出血、术后出入量有关.结论 除氧疗外,重视术前对原发病的治疗,术中减少出血,维持血流动力学稳定,同时做好全身支持治疗是预防及减轻急性肺损伤的关键.

Clinical ohservation and treatment for 189 patients with acute lung injury(ALI) after liver transplantation

Objective To further probe and investigate the etiopathogenisis of acute lung injury(ALI)after in situ liver transplantation,and to search for an effective treatment.Methods ALI was final diagnosed as the oxygen saturation index(OSI)was less than 200.The arterial blood gas analysis and others clinical examinations were timely monitored to 189 of 211 patients undergone liver transplantation in situ.The other 22 cases died of other causes at the early stage after liver transplantation.The occurring of ALI was analyzed correlatively with protopathy.All the patients were given with the therapies of oxygen,antibiotics,immunosuppressant,drugs of liver protection,nutrition,diuretics,and vasodilators,and some criteria were measured continuously.The oxygen concentration and circulation volume were adjusted accordingly with blood gas analysis and central venous pressure respectively.Results ALI occurred within 146 of 189 patients(77.5%)at the early stage after liver transplantation in situ.All the cases were treated systemically and recovered to normal.The liver function kept unvaried during the period of treatment.By analyzing the patients' data,the occurrence of ALI showed a definite relation to the hepatic decompensation of patients' primary disease,the blood loss during operation,and to the liquid intake/output postoperation.Conclusion For the purpose of preventing or reducing the incidence of ALI,It is important to pay attention to the primary disease,keep stability of the blood dynamics of the patients during or after operation.Besides the oxygen therapy,systemic general treatment is also necessary for those patients who received in situ liver transplantation.