门静脉高压症巨脾切除+贲门周围血管离断术后发热的原因分析及处理

Analysis and Treatment of Postoperative Fever in Portal Hypertension Splenectomy+Ben Peripheral Vascular Transection

目的：探讨肝硬化门静脉高压患者行脾切除＋贲门周围血管离断术后持续发热的危险因素及处理方法,以为临床提供指导。方法：收集本院2005年1月~2012年5收治肝硬化门静脉高压行脾切除＋贲门周围血管离断术治疗的患者236例的临床资料,筛选术后持续性发热患者,比较分析术后持续性发热的危险因素,并总结处理方法。结果：本组236例患者,术后出现持续性发热35例,主要原因为感染22例,脾静脉血栓5例,原因不明8例。经对症处理后,痊愈32例,死亡3例,死亡原因为感染伴肝肾功能衰竭1例,重症肺炎1例,脾静脉血栓1例。单因素分析显示急诊手术、肝功能分级差、手术时间〉4h、术后未进行全肠外营养、术后血小板明显升高是引起患者持续发热的主要危险因素（均P〈0.05）,而发热与患者性别年龄无明显关系。结论：脾切除＋贲门周围血管离断术后持续发热的原因复杂,临床应根据发热危险因素,严格筛选可手术者,围术期有效抗感染,增强患者营养状态,尽量缩短手术时间,以有效减少术后持续发热。

Objective： To investigate patients with portal hypertension underwent splenectomy pericardial blood vessel broken postoperative persistent fever risk factors and treatment methods that clinical guidance. Methods：Collect hospital in January 2005~2012 5 treated patients with portal hypertension splenectomy the＋cardia surrounding blood vessels from the off surgery in patients treated 236 cases of clinical data, screening of patients with postoperative persistent fever, a comparative analysis of persistent postoperative fever of risk factors, and summarizes the approach. Results：Of the 236 cases of patients with persistent fever after 35 cases, mainly due to the infection in 22 cases, five cases of splenic vein thrombosis, unexplained eight cases. After symptomatic treatment, 32 cases recovered, 3 cases of death, cause of death was infection with liver and kidney function failure in 1 case, 1 cases of severe pneumonia, splenic vein thrombosis cases. Univariate analysis, display emergency surgery, classification of poor liver function, operative time〉4h after surgery is not for total parenteral nutrition, postoperative platelet significantly higher in the major risk factors that cause patients with persistent fever （P〈0.05）. fever was no significant relationship with the patient sex and age. Conclusion： Splenectomy＋pericardial blood vessel transection of postoperative persistent fever because complex clinical risk factors should be based on the heat, a rigorous screening can be surgery, perioperative anti-infection effective to enhance the nutritional status of patients, as far as possible to shorten the operation time to effectively reduce the persistent postoperative fever.