常染色体显性遗传性多囊肝病术后早期并发低血压的相关因素分析及护理对策

目的探讨常染色体显性遗传性多囊肝病(autosomal dominant polycystic liver disease,ADPLD)术后早期低血压的相关因素及护理对策。方法便利抽样选取2005年1月至2013年4月在第二军医大学东方肝胆外科医院行手术治疗的ADPLD患者53例,回顾性分析其临床资料,以明确发生低血压的原因,并提出相应的护理对策。结果术后23例患者(43.4%)发生低血压。经单因素、Logistic回归分析得出ADPLD患者术后发生低血压的高危因素为术中囊液丢失量多、术中补液量少、术后低蛋白血症;低血压发生的高危时间窗为术后0~8 h,其次为8~12 h。结论做好围术期评估、根据术中出入液量术后早期合理补液、及时纠正低蛋白血症,可减少术后低血压的发生;术后12 h内加强病情观察,预见性采取干预措施,是避免患者发生严重并发症的有效措施。

Correlation Factors Analysis and Nursing Strategies of Postoperative Early Concurrent Hypotension of Autosomal Dominant Polycystic Liver Disease

Objective To investigate the correlation factors and nursing strategies of postoperative early concurrent hypotension of autosomal dominant polycystic liver disease.Methods Totally 53 ADPLD patients were randomly selected,and their clinical data were analyzed retrospectively in order to determine the causes of hypotension and propose the relevant nursing strategies.Results 23 patients（ 43.4%） developed acute postoperative hypotension.One-way analysis of variance and Logistic regression analysis showed four significant risk factors of postoperative hypotension,which were the intraoperative loss of cystic fluid volume,the intraoperative fluid rehydration,postoperative hypoalbuminemia.The high-risk time window of hypotension was within postoperative 0- 8 h,followed by 8- 12 h.Conclusion Good perioperative assessment,early postoperative reasonable fluid rehydration based on intraoperative fluid volume,and timely correction of hypoproteinemia can reduce the incidence of postoperative hypotension.Strengthening postoperative 12h observation and predictable interventions are favorable measures to avoid the occurrence of serious complications in hypotension patients.