肝移植术后胸腔积液的原因分析及防治措施

目的：探讨原位肝移植术后病人胸腔积液的原因及相应防治措施。方法：回顾45例行原位肝移植的病例的资料,分析其术后胸腔积液发生率、危险因素及相应处理措施。结果：术后32例次（32/45,71.1%）发生胸腔积液。单因素分析结果显示,术前肺功能异常、术中输液量、术中输血总量〉1000 ml、机械通气时间〉12 h、手术时间、术后再次手术、术后合并肺感染、术后合并腹水是术后发生胸腔积液的高危因素。Logistic回归分析：术前肺功能异常、术中输血总量〉1000 ml、术后机械通气时间〉12 h、术后再次手术、术后合并肺感染、术后合并腹水与胸腔积液的发生密切相关。结论：原位肝移植术后病人胸腔积液的原因是多样的。术前改善肺功能、术中尽量减少出血,控制输血量,术后积极预防感染可有效地控制胸腔积液。

Analysis the Causes and Preventive Measures of Pleural Effusion after Liver Transplantation

Objective： To study causes for pleural effusion after orthotopic liver transplantation （OLT） and the preventive and therapeutic management. Method： Data of 45 cases with OLT were studied retrospectively. Incidence of pleural effusion, risk factors and the relevant management were evaluated. Result： After OLT 32/45 cases（71.1% ） had pleural effusion. There were significances between the two groups in the following variables ： preoperative lung function, the volume of transfusion during operation, total volume of blood transfusion during operation 〉 1000ml, mechanical ventilation 〉 12 hours ,a long duration of the operation, reoperation after OLT, pulmonary infection, peritoneal effusions. Logistic regression analysis suggested that preoperative lung function, mechanical ventilation 〉 12 hours,a long duration of the operation,total volume of blood transfusion during operation 〉 1000ml, reoperation after OLT, postoperative pulmonary infection, and peritoneal effusions were independent risk factors. Conclusion： Causes for pleural effusion after OLT are many. With correct management, like improving pulmonary function, decreasing the bleeding in the operation and anti -infection effectively, pleural effusion could be improved effectively.