肝功能衰竭伴肝肺综合征的患者在肝移植中的肺功能保护

目的　探讨肝功能衰竭伴肝肺综合征的患者在肝移植中的肺功能保护及治疗策略。方法　对3年间52例肝移植中8例肝功能衰竭伴肝肺综合征的患者采用以促进移植肝功能恢复为核心的治疗;同时通过对肾功能的保护及利尿剂的应用减轻肺水肿;通过合理选择抗生素和应用微生态制剂保护和增强黏膜免疫功能;采取低潮气量加呼吸末正压通气(PEEP)及高、低氧浓度交替呼吸支持等综合治疗措施促进肝肺功能的恢复,观察肝肺综合征的逆转和肺功能的恢复情况。结果　8 例肝功能衰竭伴肝肺综合征的患者在术后2~6 周肺功能均得到明显改善。2 个月内肺功能恢复率达100%,1年生存率达75%,长期存活者均显示了良好的肺功能。结论　肝功能衰竭伴肝肺综合征是肝移植的适应证,通过围手术期的综合治疗措施,肺功能可获得逆转,患者长期存活,不留有肺部后遗症。

Protection of the lung function in liver transplantation for the liver failure patients with hepatopulmonary syndrome

Objective To investigate the protection of the lung function in liver transplantation for the liver failure patients with hepatopulmonary syndrome. Methods Clinical data of 8 liver transplanted patients with hepatopulmonary syndrome from 52 cases of liver transplantation were retrospectively analyzed to summarize the protection of the lung function in liver transplantation for the liver failure patients with hepatopulmonary syndrome. The protection of liver and renal function, the effect of microbes ferments for enhancing immunologic function of mucosal system, and the proper application of oxygen treatment was observed. Results The lung function of 8 cases has been all reversed in 2~6 weeks and recovered in 2 months after operation. One year person/liver survival rate was 75% . Conclusions The liver transplantation was an effective therapy for the liver failure patients with hepatopulmonary syndrome. The lung function of patients can be reversed and recovered through a comprehensive therapy of lung function.