成人肝移植术后肺部并发症回顾分析

目的探讨成人肝移植术后早期(3个月内)肺部并发症的种类、发生率及原因。方法回顾性分析49例肝移植术后与肺部并发症(胸腔积液、肺部感染、肺水肿、肺不张和急性呼吸功能衰竭)发生可能的相关因素。结果在肝移植术后早期有34例患者合并肺部并发症，发生率为69．4％。最常见为胸腔积液(n=26，53．1％)，其后依次为肺部感染(n=8，16．3％)、肺不张(n=6，12．3％)、急性呼吸功能衰竭(n=5，10．2％)、肺水肿(n=2，4．1％)。与未发生肺部并发症的病例相比，发生者组的死亡率明显偏高(P=0．048)，术后拔除气管插管的时间明显延长(P=0．042)，术后第1天的凝血功能较差(P=0．023)。并发胸腔积液的患者仅3例需行引流术，其他均自愈。结论采取有效措施减少危险因素，早期诊断及治疗肝移植术后的早期肺部并发症对提高肝移植患者的预后是极为重要的。

Retrospective Study on the Postoperative Respiratory Complications in Adult Liver Transplant Recipients

Purpose To explore the types,the incidence,and the causes of early postoperative (<3 months) respiratory complications in adult liver transplant (LT) recipients. Methods We reviewed the data of 49 consecutive adult LT recipients.Pulmonary atelectasis,pleural effusion,pneumonia,respiratory failure,and pulmonary edema were the respiratory complications investigated. Results Thirty-four patients (69.4%) developed at least one respiratory complication during the early postoperative period.The most frequent complication was pleural effusion (n=26,53.1%),followed by pneumonia (n=8,16.3%),atelectasis (n=6,12.3%),acute respiratory failure (n=5,10.2%),pulmonary edema (n=2,4.1%).Compared to the patients who did not develop these problems,the affected cohort showed significantly higher mortality (P=0.048) ,had longer prothrombin time after operation (P=0.023),and was required more time to extubation(P=0.042).Only three patients who suffered pleural effusion required drainage. Conclusions Reducing the risk of early postoperative respiratory complications,early diagnosis and treatment of these problems are crucial for LT recipient survival.