1例急性肝功能衰竭合并产褥感染肝移植病人的护理

急性肝功能衰竭是自黄疸的出现到脑病的发生限于8d～28d内，导致病人死亡的主要原因是神经系统损害、继发感染和多器官功能衰竭。产褥感染系指分娩及产褥期生殖道受病原体侵袭，引起局部或全身的感染。肝功能衰竭并发产褥感染时病情复杂，护理难度大。我院通过原位肝移植手术成功救治1位急性肝功能衰竭并产褥期感染的产妇。现报告如下。     

肝移植围术期的护理与监测进展

肝移植是指临床上对急性和慢性肝功能衰竭患者通过手术植入健康肝脏,使肝功能得到恢复.目前,肝移植已成为治疗终末期肝病最有效的方法[1].     

1例剖宫产术后产褥期并发严重盆腹腔感染患者的护理

正产褥感染是指患者分娩及产褥期生殖道受病原体感染引起的局部或全身性的炎症反应变化,是目前孕产妇死亡的四大原因之一,有研究显示其发病率高达6.0%~[1,2]。产妇体质虚弱、营养不良、孕期贫血、妊娠晚期性生活、胎膜早破、羊膜腔感染、慢性疾病、产科手术操作、产程延长、产前产后出血过多等因素,均可成为产褥感染的诱因~[3]。而产褥期并发盆腹腔感染若不及时诊治,可能会导致慢性盆腔炎;重者可能引起脓血症以及器官衰竭,甚至危及生命。2019年12月本院产     

急性肝功能衰竭的肝移植治疗

[目的]观察肝移植治疗急性肝功能衰竭的效果,并发症及死亡原因.[方法]总结本中心8例急性肝功能衰竭行肝移植治疗的临床资料.[结果]8例急性肝功能衰竭肝移植7例存活,1年的生存率为87.5%.术后出现肺部感染5例,1例因急性呼吸窘迫综合征(ARDS)死亡.[结论]急诊肝移植是治疗急性肝功能衰竭最有效的方法,手术指征的把握及术后的处理是提高患者生存率的关键.     

20例肝功能衰竭并发颅内出血病人的护理

肝功能衰竭是肝功能不全的晚期阶段,由于肝细胞广泛坏死或肝功能严重的损害引起的临床表现极为凶险的症候群[1].其临床特点主要表现为黄疸及凝血功能障碍,并可能出现肝性脑病、肝肾综合征、出血及感染等并发症[2],肝功能衰竭病人易并发上消化道出血已为人们所熟悉,但并发颅内出血,则因其临床变化快,症状易被其他表现所掩盖,极易出现误诊致治疗护理措施不当[3].现就本组病例如何进行观察护理介绍如下.     

人工肝治疗1例妊娠急性脂肪肝的护理

妊娠急性脂肪肝是妊娠末期发生的以肝细胞脂肪浸润,肝功能衰竭和肝性脑病为特征的疾病,预后较差,临床少见,以初产妇和双胎妊娠多见[1].南京医科大学第一附属医院感染病科曾收治了1例该病患者,用人工肝技术将患者成功救治,现将护理报告如下.……     

透析方式对患者CRP的影响与Epo疗效关系观察

C反应蛋白(CRP)是一种由肝脏合成,在急性感染、炎症和心血管系统疾病中分泌的蛋白质.是肌体炎症反应的敏感指标[1].研究发现,慢性肾功能衰竭(CRF)患者中,即使没有明确的感染,慢性炎症反应也普遍存在[2].……     

麻醉药预处理减轻肝脏缺血再灌注损伤的研究进展

缺血再灌注(isclaemia reperfusion,IR)损伤是指缺血后的再灌注不仅不能使组织器官功能恢复,反而加重组织器官的功能障碍和结构损伤.其中肝脏IR损伤即是一种常见的临床病理生理过程,休克、感染、肝脏外伤、肝叶切除及肝移植所致的肝脏功能损害、衰竭都与之有关[1].临床上如何延长肝脏热缺血耐受时问,减少肝脏损伤,保护肝功能,防止肝功能衰竭是长期以来一直尚未妥善解决的一个难题[2].     

联合试验在诊断传染性单核细胞增多症中的应用

传染性单核细胞增多症(IM)是一种由疱疹病毒(EB病毒)引起的急性或亚急性良性淋巴细胞增多的传染性疾病,是引起儿童长期发热的主要病因[1].在临床上多呈隐性感染或上呼吸道感染性炎症.IM虽属良性自限性疾病,但有时会出现一些致死性的并发症,如肝功能衰竭、脾破裂、呼吸道阻塞、持续性感染等.由于确诊IM需病原学诊断.在临床上难以开展,故易误诊和漏诊.在病程的4～10 d异常淋巴细胞、谷丙转氨酶(ALT)、血小板计数的联合检测有助于早期诊断IM.     

1例急性肝功能衰竭合并多器官功能衰竭患者的急救和护理

急性肝功能衰竭(AHF)又称暴发性肝功能衰竭(FHF),是由于各种原因引起的肝细胞大块坏死或严重的肝细胞功能损坏造成的临床综合征.临床表现为原无先天慢性肝病,出鲻现黄疸进行加重肝脏迅速缩小、肝臭、出血、脑水肿、肝性脑病、脑疝、肝肾综合征、凝血酶原时间延长、胆碱酯酶下降、转氨酶升高、血清胆红素升高[1].由于本病病情严重、预后较差、病死率较高,所以早期诊断、早期治疗,实施全面的护理是非常重要的.现将我科1例急性肝衰患者的体护理会报告如下.     

肝移植后肝功能的异常★

背景：肝移植后导致肝功能异常原因复杂，早期弄清引起肝功能异常的原因对治疗至关重要。目的：较全面的了解肝移植后可以导致肝功能异常的原因，以便应用于临床诊治。方法：应用计算机检索CNKI和FMJS数据库，采用医学主题词检索，检索词为“肝移植；肝功能异常；转氨酶异常；胆红素升高；原因”或“liver transplantation；abnormal liver function；transaminase abnormalities；bilirubin increased, and causes”，时间范围为1991年1月至2012年7月，共检索到98篇文章，选择文章主要内容与肝移植后肝功能异常直接相关的、发表在权威杂志上的文章共35篇进行综述。结果与结论：肝移植后导致肝功能异常的原因众多，临床表现复杂。最常见的原因依次是急性排斥反应、胆道并发症及病毒感染。肝移植后早期，尤其是1个月内出现肝功能异常，需警惕小体积综合征和原发性移植物无功的发生。各种原因引起的肝功能异常，转氨酶及胆红素升高的程度不尽相同。急性排斥反应、自身免疫性肝炎、病毒感染、门静脉及肝静脉狭窄、缺血-再灌注损伤等转氨酶升高较胆红素升高显著；慢性排斥反应、胆道并发症、肝动脉狭窄、原发性胆汁性肝硬化、原发性硬化性胆管炎等早期以梗阻酶碱性磷酸酶、谷氨酰转移酶、总胆红素、直接胆红素升高为主；肿瘤导致的肝功能异常视肿瘤大小、压迫部位不同，可表现出以转氨酶升高为主或以胆红素升高为主。此外，各种原因多有其特殊病史，仔细询问病史有助于早期诊断。临床工作中，应重视尽量详尽的采集病史，根据转氨酶和胆红素升高的具体情况，首先考虑引起肝功能异常的常见原因，经临床证实排除后再考虑其他相对不常见原因，并结合实验室检查、影像学检查及肝脏穿刺病理活检，尽早明确病因及治疗。     

Acute liver failure: liver support therapies

PURPOSE OF REVIEW: We summarize the therapeutic approach to patients with acute liver failure with the main focus on bioartificial and artificial liver support. We also describe specific and general therapeutic approaches based upon recent advances in the understanding of the pathophysiology of acute liver failure. RECENT FINDINGS: Bioartificial liver support systems use hepatocytes in an extracorporeal device connected to the patient's circulation. Artificial liver support is intended to remove protein-bound toxins and water-soluble toxins without providing synthetic function. Both systems improve clinical and biochemical parameters and can be applied safely to patients. Although bioartificial liver-assist devices have not been shown to improve the survival of patients with acute liver failure, further development is underway. Artificial liver support systems have been shown to alter several pathophysiological mechanisms involved in the development of acute liver failure but survival data are still limited. SUMMARY: Mortality in patients with acute liver failure is still unacceptably high. The most effective treatment, liver transplantation, is a limited resource and so other therapeutic options to bridge patients to recovery or stabilization have to be considered. Better understanding of the pathophysiology of acute liver failure and device development is necessary to achieve the elusive goal of effective extracorporeal liver assist.     

Lipid peroxidation of the liver in liver disease

Material of puncture biopsy of the human liver left after morphological study was used to explore enzymatic and non-enzymatic lipid peroxidation, NADH-ferricyanide reductase activity, the content of triglycerides, cholesterol and protein. It was shown that the degree of lipid peroxidation varies considerably in different liver diseases. The highest degree of lipid peroxidation was discovered in patients with fibrosis accompanied by the symptoms of fatty dystrophy. It was established that the rate of peroxidation does not directly correlate with the level of liver lipid infiltration. It is concluded that NADH-ferricyanide reductase activity mirrors adequately the nature of a liver disease and can be used as a highly sensitive and very specific enzymatic test.     

Management of chronic liver failure until liver transplantation

Chronic liver failure is an important cause of morbidity and mortality and is the long-term consequence of many chronic liver diseases. In addition to determining the specific cause of the chronic liver disease, which may be amenable to targeted therapy, it is important to treat the sequelae of chronic liver failure effectively to improve quality of life, to prolong survival, and to provide a bridge to liver transplantation. Once a patient who has chronic liver failure develops hepatic decompensation, liver transplantation is the definitive treatment for those who qualify. Management of chronic liver failure is the focus of this article.     

晚期肝癌合并肝包膜下出血或肝破裂出血的护理

目的总结晚期肝癌并肝包膜下出血或肝破裂出血的护理要点。方法2001年1月~2004年12月对本院收治的56例晚期肝癌并肝包膜下出血或肝破裂出血病人进行抢救治疗,并配合护理。结果治疗总有效率为80.4%,死亡率为12.5%。结论晚期肝癌并肝包膜下出血或肝破裂出血,病情变化快,死亡率高,护理的重点在于止痛、止血、并发症的急救、病情观察,心理及支持性的护理,并开展健康教育,尽量消除各种诱发因素,有效地控制出血和防止再出血,从而提高病人的生活质量。     

Antipyrine kinetics in liver disease and liver transplantation

Antipyrine kinetics were studied in seven normal subjects, 10 patients with liver disease, and 13 clinically stable patients who received a liver transplant. Five patients were studied both before and after liver transplantation. Antipyrine concentrations in saliva after oral dosing were measured by HPLC. The antipyrine t1/2 was significantly longer (P less than 0.05) in patients with liver disease than in patients undergoing liver transplantation and normal subjects. Antipyrine clearance was not significantly different between patients undergoing liver transplantation and normal subjects, but it was significantly reduced (P less than 0.05) in patients with liver disease. In five patients who were studied before and after liver transplantation, there was a significant (P less than 0.05) increase in the antipyrine clearance and a marked reduction in its t1/2 after liver transplantation. These results indicate that liver transplantation improves the drug metabolizing ability of patients with liver disease and that the oxidative metabolizing capacity of the liver in clinically stable patients after liver transplantation is similar to that of normal subjects.