门静脉高压症联合手术后患者发热的危险因素研究

Risk Factors of Fever in Portal Hypertensive Patients after Combined Operation

目的探讨门静脉高压症患者联合手术(断流术+分流术)后发热的原因及危险因素。方法对45例门静脉高压症行联合手术的患者进行回顾性+前瞻性调查。结果88%术后发热系并发症所致;胸腔积液并或脾窝、膈下积血积液或并感染最常见;持续性发热与肝功能分级显著相关(P<0.01),术前病程长曾有腹水或出血并发症,肝功能失代偿纠正不彻底,术中自由门静脉压力(FPP)≥42cmH2O、出血>800 ml、腹水、手术时间≥5 h等是术后发热的主要危险因素。结论正确掌握手术时机和适应证,术前使患者的肝功能提到A或B级、积极有效的围手术处理、细致的手术操作等是预防术后发热的有效措施。

OBJECTIVE To investigate the causes of fever and risk factors in portal hypertensive patients after combined operation （devascularization＋shunt）. METHODS Forty five cases of portal hypertension （PHT） after combined operation were retrospectively and prospectively analyzed. RESULTS Complications caused 88% post operational fever. The most common cause was hydrothorax, hematocele or hydrops and infection in splenic recess. Long-term fever was related to liver function （P〈0.01）. They were the main risk factors： long course, having aseites and bleeding, uncompletely corrected decompensated liver function, free portal pressure （FPP） ≥42cmH2O, bleeding over 800 ml, operative time≥ 5h and so on. CONCLUSIONS Effective measures of preventing post-operational fever should be taken, including the correct timing for operation and indication, liver function recovered to Child A or B, effective round-operational treats, and careful operation.