检索历史 清除

目的 探讨单位体重补液量对肝硬化患者肝移植术后新发肺水肿和急性呼吸窘迫综合征的影响.方法 回顾性分析70例肝硬化患者肝移植的临床资料,统计移植术后2周内肺部并发症的发生情况,分析患者年龄、身高、体重、体重指数(BMI)、术前肝功能、肝移植术中相关指标及术后前5天的出入量情况,分析与术后新发肺部并发症关系.结果 70例受者肺部并发症的发生率为82.9％,其中胸腔积液、肺不张、肺水肿、急性呼吸窘迫综合症、肺部感染发生率分别为60.0％、14.7％、8.6％、31.4％、10％;肺水肿发生组(6例)的术前Child-Pugh评分(9.3±1.6)、术中输血浆量(2 667±1 164) ml、单位体重输血浆量(39.4±19.0) ml/kg、输人工胶体量(1 417±376) ml与术后第3天单位体重补液量(53.2±9.3)ml/kg与未发生组(64例)的术前Child-Pugh评分(7.6±1.9)、术中输血浆量(1 753±1 040)ml、单位体重输血浆量(24.2±15.7) ml/kg、输人工胶体量(2 347±1 088)ml、术后第3天单位体重补液量(44.6±10.1)ml/kg)比较,P=0.028、P=0.046、P =0.029、P=0.046、P=0.046,差异有统计学意义;发生急性呼吸窘迫综合征组(22例)术中单位体重输血浆量(31.3±20.4) ml/kg、术后第1天的液体平衡(1 504±894) ml、单位体重液体平衡(22.1±13.1)ml/kg、术后第3天的单位体重补液量(49.0±10.1) ml/kg与未发生组(48例)术中单位体重输血浆量(22.7±13.4)ml/kg、术后第1天的液体平衡(910±684) ml、单位体重液体平衡(12.7±9.9)ml/kg、术后第3天的单位体重补液量(43.6±9.9)ml/kg比较,P=0.045、P =0.003、P=0.001、P =0.042,差异有统计学意义.结论 肝硬化患者肝移植术后新发肺部并发症的发生率较高,术中在维持血流动力学稳定的前提下,应适当增加人工胶体的应用,减少过多的血浆输注,术后第1天及第3天,应根据受者的体重限制过量补液,以降低发生术后肺部并发症的风险.

Objective To explore the effects of infusion per unit of weight on pulmonary edema and acute respiratory distress syndrome (ARDS).Methods The clinical data of 70 patients with cirrhosis who had accepted liver transplantation were retrospectively collected,including the age,height,weight,BMI,preoperative liver function,indexes during liver transplantation and the postoperative intake and output records in the first 5 days,and the emerging postoperative pulmonary complications (EPPCs) in the first 2 weeks were screened.The relationship between clinical data and new pulmonary edema and ARDS was analyzed.Results The incidence rate of NPPCs was 82.9 ％,in which the incidence rate of pleural effusion,atelectasis,pulmonary edema,ARDS and pulmonary infection was 60.0％,14.7％,8.6％,31.4％ and 10％ respectively.In the pulmonary edema group (n =6),the preoperative Child-Pugh score (9.3 ± 1.6),the total volume (2 667 ± 1 164) ml and the volume of unit weight (39.4 ± 19.0) ml/kg of plasma transfusion,the total volume (1 417 ± 376) ml of artificial colloid during operation,and the input of unit weight (53.2 ± 9.3 ml/kg) on the 3rd day after operation were significantly different from those (7.6 ± 1.9,1 753 ± 1 040 ml,24.2 ± 15.7 ml/ kg,2 347 ± 1 088 ml,and 44.6 ± 10.1 ml/kg) in the group (n =64) without pulmonary edema.Their P values in the order were 0.028,0.046,0.029,0.046,and 0.046.In the ARDS group (n =22),the plasma transfusion volume per unit of weight during operation (31.3 ± 20.4 ml/kg),the total balance volume equaled with the difference of input and output (1 504 ± 894 ml) and the balance volume per unit of weight (22.1 ± 13.1 ml/kg) on the first postoperative day and the total input volume per unit of weight on the third postoperative day (49.0 ± 10.1 ml/kg) were significantly distinguished with those (22.7 ± 13.4 ml/kg,910 ± 684 ml,12.7 ± 9.9 ml/kg,and 43.6 ± 9.9 ml/kg) in the group (n =48) without ARDS.The P values in the order were 0.045,0.003,0.001 and 0.042 respectively.Conclusion The incidence rate of NPPCs in the patients with cirrhosis receiving the liver transplantation is relatively higher.In order to reduce the risk of NPPCs,based on the hemodynamic stability during operation,the artificial colloids should be appropriately increased and excessive plasma transfusion reduced.In addition,the redundant input should be limited according to the weigh,in the first and third postoperative days.