肝移植术后早期补液治疗与肺部并发症关系的探讨

Study on the correlation and its nursing strategies between postoperative early fluid therapy and pulmonary complication after liver transplantation

目的探讨肝移植术后补液治疗与肺部并发症的关系及护理对策。方法对我院肝移植术后病例进行回顾性分析,根据术后早期液体出入量监测的结果,分为平衡补液组(液体入量=液体出量)和负平衡补液组(液体平衡≤500 ml)两组。观察其肺部并发症发生的情况。结果74例患者中,术后早期发生肺部并发症29例(39.19%),其中负平衡补液组7例(18.42%),平衡补液组22例(61.11%)。负平衡补液组患者术后动脉血气PaO2和PaO2/FiO2值均明显高于平衡补液组(P<0.01),而术后肛门排气时间及住院时间短于后者。结论肝移植术后前3 d内至少有2 d在血液动力学稳定的前提下,适当的液体负平衡,可以减少肺部并发症的发生,促进术后恢复。

Objective To study the correlation between postoperative early fluid therapy and pulmonary complication after liver transplantation, and to provide effective nursing care. Method 74 patients with liver transplantation were retrospectively analyzed. Patients were divided into fluid balance group（fluid volume of infusion equal to fluid volume of drainage）and negative fluid balance group（volume of fluid balance ≤500ml）basing on the monitoring outcome of fluid volume of infusion and drainage. The occurrence rate of pulmonary complication in these cases was observed and compared. Result The pulmonary complication occurred in 29 cases after liver transplantation in early stage（39.19%）, including 7 patients in the negative fluid balance group （18.42%）and 22 patients in the fluid balance group（61.11%）. The arterial blood gas PaOz and PaO2/FiO2 in negative fluid balance group was significant higher than the fluid balance group（P〈0.01）. However, the time of initial passage of flatus and hospital length of stay of the former was shorter than that of the latter. Conclusion Maintaining Proper negative fluid balance more than 2 days during the first three days in the early stage after liver transplantation basing on the stable haemodynamics could reduce pulmonary complication and promote the patients recovery.