原位肝移植术后心血管并发症的临床处理

目的 总结肝移植术后常见的心血管系统并发症及其可能的原因和防治方法。方法 对中山大学第一附属医院1993年4月至2001年12月间的肝移植病例住院期间术后近期发生的心血管系统并发症进行回顾性分析。结果 88位患者实施了89例次肝移植,65例患者发生心血管系统并发症,同心血管并发症相关的病死率为12.4％(11/89)。术后凝血功能紊乱可能是发生心肌缺血的主要原因;心力衰竭程度随术中输血量不同差异有显著性(x~2=5.714,P<0.05);术后高血压的发生与多种因素有关。结论 心血管系统并发症是肝移植术后常见的和严重的并发症之一,并有较高的病死率。合适的病例选择,维持凝血机制及出入量的平衡是降低术后心血管并发症的关键。

The clinical management of cardiovascular complications after orthotopic liver transplantation

Objective To report the incidence and analyze the factor predisposing to cardiovascular complication after orthotopic liver transplantation (OLTx). Methods A retrospective study was made for the patients who develop of all cases in which patients presented with cardiovascular complications after OLTx from April 1993 to December 2001 in the First Affiliated Hospital of Sun Yat-sen University,Guangzhou. Result Eighty-nine liver transplants were performed in 88 patients. Cardiovascular complications developed in 65 (73%) patients. Among these 65 complications,6 were myocardiac ischemia,9 were heart failure,59 were hypertension and 5 were pulmonary hypertension,portoperative mortality rate related to cardiovascular complication was 12.4% (11/89). Except for the preexisting coronary artery disease,the unbalance between coagulant and anticoagulant function in patients after OLTx may play a role in myocardiac ischemia after OLTx. Heart failure was correlated with massive intraoperative blood transplantation (x2=5.714,P<0.05). Conclusion Cardiovascular complications are common after OLTx. They are severe and highly related to mortality. The unbalance between coagulant and anticoagulant function in patients after OLTx resulting in the thrombosis in coronary artery may be the cause of myocardiac ischemia. Massive intraoperative blood transplantation may be responsible for heart failure.