TIPSS治疗肝硬化门脉高压症的术后并发症及护理

目的:探讨经颈静脉肝内门体支架分流术(transjugular intrahepatic portosystemic stent-shunt,Tipss)治疗肝硬化门脉高压症的并发症及护理。方法:对我院50例肝硬化Child-Push分级B、C级患者分别给予Tipss术,术中、术后严密观察病情变化、手术进程及各种并发症的发生情况,并针对不同情况,给予细致的护理观察,总结观察结果。结果:50例患者术后平均门静脉压力下降20cm H2O,术后肝硬化门脉高压患者的腹水或上消化道出血两大并发症得到不同程度的缓解;术后1月内,除1例1周后支架即闭塞,1例术后即并发严重肝性脑病外,未见其他并发症的发生,远期并发症主要以反复的肝性脑病及支架闭塞为主,其他肝静脉闭塞、肝性神经病变较少见;术后1月复查肝功,平均Child积分变化不大。结论:Tipss是治疗肝硬化合并门脉高压症有效方法,术后门脉压力缓解明显,但术后支架狭窄与肝性脑病高发,通过加强护理可降低其发生率,但肝性脑病仍处在较高的水平,是Tipss开展的又一难题。

Clinical nursing of the complications of TIPSS on portal hypertension of liver cirrhosis

Objective：To explore complications and nursing after the transjugular intrahepatic portosystemic stent shunt（Tipss） to treat portal hypertension. Methods：50 patients from our hospital with liver cirrhosis of Child-Push grade B,C-class were given Tipss surgery;complications and surgical process were strictly observed intraoperatively and postoperatively and then for different situations to give careful nursing and observations,nextly to conclud observations.Results：The average decreazation of portal vein of the 50 patients are 20 cm H2O;both the ascites and the upper gastrointestinal bleeding are relieved with different extents;in addition to 1 case with stents occlusion after 1 week,1 patient severe hepatic encephalopathy,there is no other complications occurring recently;there mainly are stents occlusion and hepatic encephalopathy in long-term complications but the hepatic vein occlusion and hepatic neuropathy lessly;there are no differret changes in liver function 1 moths later.Conclusion：Tipss is the effective way of the treatment of the hepative cirrhosis portal hypertension,and can decrease portal pressure nursing,but there are high occurences of the stent stenosis and the hepatic encephalopathy after TIPSS;although by carely atcendance can reduce its incidence,but the hepatic encephalopathy is still the stock of the use of TIPSS.