原位肝移植术后并发高钠血症的监护

Investigation of hypernatremia after orthotopic liver transplantation and the monitoring strategies

目的分析原位肝移植术后并发高钠血症的发生情况,以提高监护水平。方法收集2004年1月-2005年1月本院111例终末期肝病行原位肝移植术的患者资料,分析高钠血症患者的一般情况,并进行严密监护。结果111例患者中,47例出现高钠血症,占42.34%,其中7例进入监护病房时即发现高钠血症,其余40例均在监护病房出现高钠血症,治愈31例,死亡16例,死亡率占34.04%。结论原位肝移植发生高钠血症的发生率为42.34%,死亡率高达34.04%,提示高钠血症是原位肝移植预后不良的重要指标。早期发现,及时治疗,并根据原发病和高钠血症的原因选择液体调控的途径和液体类型,肠外和肠内治疗相结合,必要时肾脏替代治疗（CRRT）。

Objective To analysis the incidence of hypernatremia after orthotopic liver transplantation（OLT）in order to enhance the monitoring level. Methods 111 terminal hepatopathy patients with hypernatremia after OLT from January 2004 to January 2005 were retrospectively analyzed and monitored exactly. Results 47 cases of the 111 patients had hypernatremia, with the incidence rate of 42.34%. Among 47 patients, 7 patients were diagnosed as hypernatremia immediately when admitted to SICU. The other 40 patients had hypernatremia in the hospitalization at SICU. 31 patients recovered and 16 patients died, with the mortality of 34.04 %. Conelusions The incidence rate of hypernatremia after OLT is 42. 34 % and the mortality is as high as 34.04%. It shows that hypernatremia is an important index of worse prognosis in OLT. Early discovery and prompt treatment are the key points. On the basis of primary disease and the cause of hypernatremia, the methods and types of liquid addition are selected to regulate. Parenteral and enteral pathways are combined together and Continue Renal Replacement Therapy （CRRT） is ready in case of necessity.