慢加急性肝衰竭肝移植的围手术期管理

Management of liver transplantation perioperative period in acute-on-chronic liver failure

慢加急性肝衰竭(ACLF)是发生在慢性肝病伴或不伴肝硬化患者中的一种潜在可逆性疾病,具有肝外器官功能衰竭和短期内高病死率的特点。肝移植是目前治疗ACLF患者最有效的治疗手段,其手术时机和禁忌证需重点关注。ACLF患者肝移植围手术期应积极开展心、脑、肺、肾脏等重要脏器功能的支持保护;重点在麻醉选择、术中监测、肝移植三阶段管理、再灌注后综合征防治、凝血功能监测管理、容量监测管理和体温监测管理方面加强肝移植麻醉管理水平。建议术后常规进行重症监护治疗,围手术期全程应关注移植物及其他重要脏器功能,促进ACLF患者术后早期康复。

Acute-on-chronic liver failure(ACLF)is a potentially reversible entity that occurs in patients with chronic liver disease accompanied with or without cirrhosis and is characterized by extrahepatic organ failure and high short-term mortality.Currently,the most effective treatment method for patients with ACLF is liver transplantation;therefore,admission timing and contraindications must be emphasized.The function of vital organs such as the heart,brain,lungs,and kidneys should be actively supported and protected during the liver transplantation perioperative period in patients with ACLF.Focusing on the anesthesia management level during anesthesia selection,intraoperative monitoring,three-stage management,prevention and treatment of post-perfusion syndrome,monitoring and management of coagulation function,volume monitoring and management,and body temperature monitoring management for liver transplantation should strengthen anesthesia management.Additionally,standard postoperative intensive care treatment should be recommended,and grafts and other vital organ functions should be monitored throughout the perioperative period to promote early postoperative recovery in patients with ACLF.