肝移植病人围术期低氧血症的防治

目的：探讨肝移植病人围术期影响呼吸功能的因素以及对低氧血症的预防和治疗措施。方法：回顾性分析了3例背驮式原位肝移植（POLT）患者的临床资料,对肝移植病人围术期发生的呼吸功能不全的原因进行分析,结果：围术期存活2例,死亡1例,术后并发急性呼吸衰竭,感染,急性排斥反应,肾衰等。结论：减少外科手术并发症是提高肝移植患者手术成功率以及长期存活的关键;呼吸“泵”衰竭是低氧血症形成的重要原因之一;及时有效的氧疗和机械通气是治疗肝移植病人术后并发症的一项重要措施。

The change of respiratory function and prevention of hypoxemia of orthotopic liver transplantation during perioperative period

Objective: To study factors affecting respiratory function and prevention of hypoxemia in the patients with liver transplantation during perioperative period. Methods: Three patients with end staged liver diseases underwent liver transplantation between June 2000 and Feb 2001 were retrospectively analyzed. Prevention of respiratory function disorder and hypoxemia were systematically assessed during postoperative management. Results: Two patients survived for more than one month. Another patient died within 30 days from multiple organ failure after POLT. Major complications were respiratory failure? primary hepatic nonfunction? infection ?acute rejection and acute renal failure. Conclusion: Technical aspects of the operation are the most critical determinants of early outcome. Respiratory "pump" failure is one of important causes for hypoxemia. Mechanical ventilation and oxygen treatment are an effective approach in liver transplantations.