自体肝干细胞移植治疗慢性肝衰竭病人的护理

慢性肝衰竭为各种原因反复发作于肝脏而造成的弥漫性损害,当被病毒感染后,肝细胞损伤呈现广泛性,窦周细胞周围的成熟肝细胞和肝脏干细胞无法分裂、再生.     

自体肝干细胞移植治疗慢性肝衰竭病人的护理

慢性肝衰竭为各种原因反复发作于肝脏而造成的弥漫性损害，当被病毒感染后，肝细胞损伤呈现广泛性，窦周细胞周围的成熟肝细胞和肝脏干细胞无法分裂、再生，影响肝脏的修复。探索将骨髓来源的干细胞种植到肝脏，并诱导其增殖、分化形成正常的肝组织细胞，以代替病变肝脏组织细胞功能，已成为肝脏病学中研究的热点。国内姚鹏等报告，应用人自体骨髓干细胞移植治疗慢性肝衰竭，接受自体骨髓于细胞移植后，病人肝功能均明显改善。为了探求治疗慢性肝衰竭新的治疗方法，我科于2005年11月-2008年7月采用自体肝干细胞移植治疗慢性肝衰竭病人共16例，取得较满意效果，现将护理体会报告如下。     

Respiratory failure after liver transplantation

Summary A rapidly growing haemangioendothelial sarcoma of the liver in a twenty-two year old woman was treated by liver transplantation. Disseminated intravascular coagulation resulted in massive blood loss during surgery, and contributed to the death of the patient from respiratory failure on the fourth post-operative day, despite continuous postoperative intermittent positive-pressure ventilation. Other factors leading to her respiratory failure are discussed. There was no evidence of dysfunction in the transplanted liver.     

骨髓间充质干细胞移植治疗慢性肝衰竭的护理

目的 探讨骨髓间充质干细胞移植治疗慢性肝衰竭的临床护理措施及效果观察.方法 对2009年7月～2009年12月在我科行骨髓间充质干细胞移植治疗的20例慢性肝衰竭患者的临床资料进行回顾分析.结果 20例骨髓间充质干细胞移植围手术期成功率达100%.术后12周,患者白蛋白、总胆红素、凝血酶原时间及纤维蛋白原均有显著性改善(...     

Pulmonary aspects of chronic liver disease and liver transplantation

A vast spectrum of pulmonary pathologic conditions occurs in association with chronic liver diseases, and clinically important manifestations, such as arterial hypoxemia, can result. Both pulmonary vascular and parenchymal abnormalities can contribute to the dysfunction, as evidenced by results of pulmonary function tests and gas exchange studies. The clinical implications of identifying such pulmonary problems range from alleviation of symptoms, especially dyspnea, to comprehensive assessment of patients before and after liver transplantation. Physicians should be aware of these potential pulmonary disorders that can complicate liver disease and liver transplantation so that management of affected patients can be improved.     

Quality of life following emergency liver transplantation for acute liver failure

INTRODUCTION: Liver transplantation is an accepted and successful therapy for both acute and chronic liver diseases (CLDs), with good survival outcomes. Whilst the study of health-related quality of life (HRQoL) post transplantation for CLDs have been well documented, there is little data measuring HRQoL following liver transplantation for acute liver failure (ALF) patients. PATIENTS AND METHODS: Data were collected using between-method triangulation; however, only the quantitative element of the study is reported here. Measuring eight health domains, we distributed the short form 36 (SF-36) questionnaire by post to 96 acute and chronic transplant recipients. Differences between the groups were measured using both parametric and non-parametric t-tests. RESULTS: Overall, the patients showed a satisfactory HRQoL; there were no differences between either acute or chronic transplant groups in seven of the eight domains of quality of life. Among the patients transplanted for ALF, there were no differences in HRQoL between patients transplanted for paracetamol hepatotoxicity compared with other indications, and no variations in HRQoL related to recipient gender, employment or length of survival post transplantation. When compared with the UK SF-36 normal values to the ALF transplant recipients, there was a significantly lower physical functioning and role emotional scores. CONCLUSION: Regardless of aetiology, most of recipients transplanted for ALF have a HRQoL comparable with chronic transplant recipients.     

Management of hypertension in chronic heart failure

Chronic heart failure (CHF) is associated with frequent hospitalizations and high mortality. It affects more than 5 million individuals in the USA, and another 660,000 new cases are diagnosed each year; overall, heart failure (HF) now accounts for 7% of all deaths from cardiovascular disease. Hypertension (HTN) increases the risk of development of HF and it precedes it in 75% of cases. HF patients are nearly evenly divided between those with reduced left ventricular (LV) function or systolic dysfunction and those with preserved LV systolic function or diastolic dysfunction. The management of HTN in patients with CHF is challenging. Drugs such as β-blockers, angiotensin-converting enzyme inhibitiors, angiotensin receptor blockers, aldosterone receptor blockers, hydralazine and nitrates, which have shown mortality benefit in CHF and exert antihypertensive effects, should be used as first-line agents to control HTN in CHF. In addition, antihypertensive drugs such as α-receptor blockers that can increase mortality in HF should be avoided. The dihydropyridine group of calcium channel blockers are good antihypertensive medications with a neutral effect on mortality in patients with CHF. These may be used in CHF patients with refractory HTN. In patients with HF with reduced ejection fraction, HTN is treated differently in comparison to patients with HF with normal ejection fraction. This article reviews the treatment of essential HTN in patients at risk for developing HF, in the presence of HF and the latest developments in treatment that might benefit both HTN and HF management.     

Nursing care of chronic and acute liver failure

The authors describe the structure and functions of the liver, as well as the main causes and symptoms of chronic and acute liver failure. The nursing assessment and management of patients with liver disease are also examined.     

肝移植治疗重型肝炎/肝衰竭的手术时机

肝移植已成为治疗各种原因所致的急慢性肝功能衰竭患者的一种有效治疗手段,但是关于重型肝炎/肝衰竭肝移植治疗的手术时机选择问题,目前国内外尚无统一标准。本文旨在通过总结国内外肝移植治疗肝衰竭的相关文献,结合我中心肝移植治疗重型肝炎/肝衰竭的经验,探讨肝移植治疗重型肝炎/肝衰竭的手术时机。     

终末期肝衰竭患者肝脏移植术后血流动力学变化

目的 :观察终末期肝衰竭患者肝脏移植术后的血流动力学变化。方法 :5例终末期肝衰竭患者行肝脏移植手术 ,监测其手术后 3日内中心静脉压 (CVP)、肺动脉压 (PAP)、肺小动脉楔压 (PAWP)、心排血量 (CO)和平均动脉压 (MAP)等参数的变化。结果 :患者术后进入 ICU当时的 MAP、肺毛细血管楔压 (PCWP)和 CVP均明显低于正常参考值 ,心率 (HR)显著增快 ;术后 3日内经过积极扩容 ,MAP、PCWP和 CVP显著升高(P均 <0 .0 1)。入 ICU后 8小时内的心脏指数 (CI)轻度降低 ,但与术后 2 4、4 8小时的 CI值比较均无显著性差异 (P均 >0 .0 5 )。入室后 8小时内的外周血管阻力指数 (SVRI)、肺血管阻力指数 (PVRI)轻度降低 ;术后 3日内上述指标逐渐恢复正常。结论 :终末期肝衰竭患者肝移植术后血流动力学不稳定 ,出现明显的血容量不足表现 ,如不及时纠正可能导致脏器灌注不足 ,乃至器官功能衰竭 ,因此 ,密切监测其血流动力学的变化 ,估计其血容量不足状态并予充分纠正 ,是肝移植患者安度围手术期的关键     

肝移植后肾功能衰竭者的连续血液净化治疗

背景:连续性血液净化又称为肾脏替代疗法,是近年来血液净化治疗技术的一项重要发展,在临床上已成为救治急性肾功能衰竭、多脏器功能衰竭及各种急危重患者必不可少的治疗手段.目的:总结肝移植后合并肾功能衰竭患者应用连续性血液净化的治疗技术.方法:回顾性分析10 例肝移植后合并急性肾功能衰竭的患者应用BM-25 连续性血液净化机治疗的临床资料,治疗模式为连续静静脉血液滤过,置换液使用方式是前/后稀释法,采用普通肝素、低分子肝素或无肝素抗凝.治疗时间为5～30 d.观察患者治疗前及治疗24 h 后心率、平均动脉压、中心静脉压、尿素氮、血肌酐、血清钾、动脉血气碱剩余.结果与结论:10 例患者中,好转8 例,ICU 存活率80.0%.连续性血液净化治疗过程中患者生命体征平稳、血流动力学指标好转,全身水肿逐渐减轻,呼吸状态好转.治疗24 h 心率显著下降,平均动脉压明显升高,中心静脉压显著下降.电解质、酸碱平衡维持正常,动脉血气明显改善,尿素氮、血肌酐、血钾明显降低.治疗前后两组数据比较,差异有显著性意义(P ＜ 0.05).提示连续性血液净化治疗能明显改善肝移植后急性肾功能衰竭患者的预后,因而在肝移植后并发急性肾功能衰竭患者中得以广泛应用.     

肝移植后肾功能衰竭者的连续血液净化治疗

背景：连续性血液净化又称为肾脏替代疗法,是近年来血液净化治疗技术的一项重要发展,在临床上已成为救治急性肾功能衰竭、多脏器功能衰竭及各种急危重患者必不可少的治疗手段。目的：总结肝移植后合并肾功能衰竭患者应用连续性血液净化的治疗技术。方法：回顾性分析10例肝移植后合并急性肾功能衰竭的患者应用BM-25连续性血液净化机治疗的临床资料,治疗模式为连续静静脉血液滤过,置换液使用方式是前/后稀释法,采用普通肝素、低分子肝素或无肝素抗凝。治疗时间为5～30d。观察患者治疗前及治疗24h后心率、平均动脉压、中心静脉压、尿素氮、血肌酐、血清钾、动脉血气碱剩余。结果与结论：10例患者中,好转8例,ICU存活率80.0%。连续性血液净化治疗过程中患者生命体征平稳、血流动力学指标好转,全身水肿逐渐减轻,呼吸状态好转。治疗24h心率显著下降,平均动脉压明显升高,中心静脉压显著下降。电解质、酸碱平衡维持正常,动脉血气明显改善,尿素氮、血肌酐、血钾明显降低。治疗前后两组数据比较,差异有显著性意义（P〈0.05）。提示连续性血液净化治疗能明显改善肝移植后急性肾功能衰竭患者的预后,因而在肝移植后并发急性肾功能衰竭患者中得以广泛应用。     

血液滤过联合灌流治疗肝移植术后急性肝衰竭的临床观察

目的评价血液滤过联合血液灌流对肝移植术后出现急性肝衰竭患者的临床治疗价值。方法采用血液滤过联合血液灌流治疗9例肝移植术后发生急性肝衰竭的患者,检测治疗前后血常规、肝肾功能等指标并进行比较。结果患者进行血液滤过联合血液灌流治疗后,血液生化指标较治疗前明显下降,其中总胆红素(TB)、血氨(NH3)、谷丙转氨酶(ALT)、尿素氮(BUN)、肌酐(Cr)治疗前后对比具有统计学意义,临床症状明显改善。结论对肝移植术后患者,进行血液滤过联合血液灌流治疗,可有效清除及吸附血液中TB、NH3、ALT、BUN、Cr,是肝移植术后恢复的有效措施之一。