老年肝移植围手术期并发症的发生与防治——附4例临床病例报告

The development and treatment of the perioperative complication of the liver transplantation in the elderly patients——attached to the clinical report of 4 cases

目的探讨老年肝移植围手术期并发症的发生原因及其防治策略。方法对4例老年肝移植患者术前术中术后全程监护与治疗,系统分析患者入院诊断、术前评估、手术与麻醉方式、围手术期并发症发生发展及治疗转归。结果4例患者均为多发性原发肝癌,其中术前合并高血压3例、糖尿病2例、肝功能不全1例、乙型肝炎病毒相关性肾病1例。术中发生休克2例、乳酸中毒行血滤1例、频发室性早搏1例、心肌缺血2例、术后发生心力衰竭1例、心肌缺血1例、心肌损伤1例、窦性心动过速4例、频发室性早搏2例、大出血再次手术1例、贫血4例、胸腔积液4例穿刺引流1例、伤口不愈合再次缝合1例、高血糖4例、急性肾功不全高钾血症行血滤1例、一过性谷丙转氨酶升高3例。4例均存活。结论正确地认识、预防和治疗老年肝移植围手术期并发症是保障老年肝移植患者手术成功的基本策略。

Objective To detect the evidence for the diagnosis and treatment of the complication during the perioperative perlod,and to investigate the dignostic and therapeutic conditions and characteristics of the clinical abnormalities in the elderly patients treated with the liver transplantation. Methods The medical records of 4 elderly patients treated with the liver transplantation were analyzed including diagnosis inhospital,estimation to medical condition of the patient ,the method of the operation and anesthesia,the development of the complication and its treatment results during the perioperative period. Results Four patients were diagnosed as multiple primary carcinoma of liver before the operation,of them there were, 3 patients with hypertention, 2 patients with diabetes, 1 patient with disfunction of liver, 1 patient with hepatitis-associated nephropathy. During the operation of liver transplanta- tion,there were 2 patients with shock, 1 patient with hematotoxicosis of lactic acid who was treated by hemodialysis, 1 patient with frequent ventricular premature constraction ,2 patients with myocardial iscbemia, of 4 patients. And after the operation of liver transplantation,of 4 patients there were 1 patient with heart failure, 1 patient with myocardial ischemia, 1 patient with myocardial injury,4 patient with sinus tachycardia,2 patients with frequent ventricular premature constraction,1 patient with severe bleeding who was treated by hemostatic operation,4 anemic patients,one treated by pleurocentesis of 4 patients with hydrothorax,4 patients with hyperglycemia, 1 patients with acute dysfunction of kidney who treated by hemodialysis,3 patients with high level of GPT in the short duration. Four patients are all alive at present. Conclusions The basic strategy of performing operation of the liver transplantation successfully is to diagnose accurately and to appropriate treat the perioperative complication in the elderly patients.