布-加综合征的围手术期处理体会

The perioperative management for the patients with Budd Chiari syndrome

手术治疗布加综合征５０２例。围手术期处理措施包括：①术前进行下腔静脉与肝静脉造影，以选择适当术式；纠正营养不良、贫血及肝功能异常。②术中经上腔静脉属支建立输液通路；自体血回输；解除下腔静脉阻塞后，应逐渐增大回心血量，以防心衰；病变远心侧血栓应彻底取出，以防肺动脉栓塞。③术后应用抗凝祛聚药物。结果显示，手术治疗的有效率８５７％，死于围手术期并发症１４例（２８％）。提示加强围手术期处理对减少并发症、提高疗效，具有重要意义。

In this study,502 patients with Badd Chiari syndrome were treated with different operations.Perioperative managements included:(1)preoperative preparations:phlebography of inferior vena cava (IVC) and percutaneous transhepatic hepatophlebography were performed in order to decide the operative procedure;the patients accompanying with malnutrition,anemia and hepatic insufficiency should be treated. (2) intraoperative managements:transfusion and central vein pressure monitoring sets were installed through the branches of superior vena cava;autotransfusion was performed. If the IVC consisted thrombus, it should be removed first,and then resume the blood flow;blood flow to the right atrium would be increased gradually to avoid heart failure after IVC obstruction was resolved. (3) postoperative care and treatment:vital sign monitoring in the early postoperative period was necessary;anticoagulant therapy should be done for half a year to prevent thrombosis in IVC and hepatic veins. The results indicated that the effective rate of operation was 87.5%, and 14(2.8%) patients died from perioperative complications. The authors consider that it is important to strengthen perioperative management for decreasing complications and improving curative effect in patients with BCS.