伴发肝功能异常的普外科病人围手术期管理

Management of perioperative patients with abnormal liver function

无论术前肝功能是否正常,普外科手术后的病人均可出现肝功能异常。围手术期对病情进行严密监测和及时发现肝功能异常,对避免术后肝损害有着至关重要的作用。对于术前肝功能正常的病人,应注意避免诱发肝功能异常的因素。对于术前即存在急慢性肝病的病人,术前需全面评价肝功能,围手术期采取改善凝血功能、营养状态及控制感染、腹水等措施;术中注意避免麻醉药物、感染及缺血等原因导致的肝功能损害;术后严密监测肝脏功能,避免一切加重肝损害的诱因。

All the patients who undergo general surgery will develop abnormal liver function tests postoperatively no matter whether the preoperative liver function is normal. Close monitoring and prompt treatment perioperatively are vital to protecting patients from liver damage. For patients with normal liver function before operation, factors that can induce abnormal liver function should be avoided. For patients with pre-existing liver diseases, preoperative liver function should be assessed comprehensively. Measures should be taken to improve the blood clotting function, nutrition status and to control infection and ascites perioperatively. Anesthetic medicines, infections , ischemia and other causes of liver damage should be avoided during operation. Close monitoring of liver function and careful avoidance of factors that can damage liver are mandatory postoperatively.