CAJ | 학술논문

目的总结肝移植术后早期并发消化道瘘的护理体会.方法 2000年1月至2010年12月共完成1173例次尸体肝移植,61例术后早期并发消化道瘘.回顾性分析61例患者的临床资料及其护理要点.结果肝移植术后早期并发消化道瘘的发生率为5.20％.其中胆瘘发生率为3.90％,胃瘘为0.42％,十二指肠瘘为0.08％,空肠瘘为0.34％,回肠瘘为0.08％,横结肠瘘为0.34％.肝移植术后早期并发消化道瘘的时间为3～24 d,临床表现有:发热,腹痛,腹胀,肠蠕动减弱,甚至发生感染性休克.实验室检查可出现白细胞计数升高或下降、肝酶学及总胆红素升高等.经保守或手术治疗后,4例胆瘘患者死亡,7例肠瘘患者死亡.其余50例康复出院.结论肝移植术后早期消化道瘘的发生率低,但死亡率高.密切观察患者的病情变化争取早期诊断,及时恰当处理,以有效提高肝移植并发消化道瘘的治疗效果.同时做好心理护理、基础护理、饮食护理等,提高患者的生存率和生活质量.
목적 총결간이식술후조기병발소화도루적호리체회.방법 2000년1월지2010년12월공완성1173례차시체간이식,61례술후조기병발소화도루.회고성분석61례환자적림상자료급기호리요점.결과 간이식술후조기병발소화도루적발생솔위5.20％.기중담루발생솔위3.90％,위루위0.42％,십이지장루위0.08％,공장루위0.34％,회장루위0.08％,횡결장루위0.34％.간이식술후조기병발소화도루적시간위3～24 d,림상표현유:발열,복통,복창,장연동감약,심지발생감염성휴극.실험실검사가출현백세포계수승고혹하강、간매학급총담홍소승고등.경보수혹수술치료후,4례담루환자사망,7례장루환자사망.기여50례강복출원.결론 간이식술후조기소화도루적발생솔저,단사망솔고.밀절관찰환자적병정변화쟁취조기진단,급시흡당처리,이유효제고간이식병발소화도루적치료효과.동시주호심리호리、기출호리、음식호리등,제고환자적생존솔화생활질량.
Objective To summarize nursing experience of digestive tract fistula after orthotopic liver transplantation (OLT). Methods From January 2000 to December 2010,1173 patients received liver transplantation,among whom 61 recipients got digestive tract fistula during early stage after operation.The clinical data and major nursing measures of 61 patients were studied retrospectively. Results The incidence rate of digestive tract fistula after OLT was 5.20％.The incidence rate of bile leakage,gastric fistula,duodenal fistula,jejunal fistula,ileal fistula and transverse colon fistula were 3.90％,0.42％,0.08％,0.34％,0.08％ and 0.34％,respectively.The onset time of digestive tract fistula was from 3 to 24 days post transplantation,and atypical symptoms such as fever,abdominal pain,abdominal distention,weakened enterocinesia and even septic shock were presented.And the rising or descending of white blood cells counts,rising of level of transaminase and total bilirubin in laboratory examination were simultaneously presented.Four patients died of bile leakage,and other seven patients died of intestinal fistula throughout conservative or operative treatment.The rest of 50 were discharged healthily. Conclusions The morbidity of digestive tract fistula after OLT is low,but its mortality rate is high.It is necessary to closely observe patients' condition and confirm diagnosis in early stage,in order to promote the healing of digestive tract fistula after OLT.At the same time,psychological,basic and dietary nursing should be given in order to enhance the survival rate and quality of life of patients.