CAJ | 학술논문

肝移植术后肺部并发症的发生率非常高,包括肺不张、胸腔积液、肺水肿、肺部感染和急性呼吸衰竭等,严重影响病人的预后.引起肝移植术后肺部并发症的因素很多,主要包括手术操作、感染、循环容量超负荷、输血相关的急性肺损伤、缺血/再灌注、呼吸机相关性肺损伤、肝肺综合征和门肺高压症等因素,以此为依据,现提出了具体的防治措施,包括完善的术前准备、防止容量超负荷、合理输血和血制品,调节凝血功能,注意预防输血相关的急性肺损伤(transtnsion related acutte lung injury,TRALL)、合理应用抑肽酶、减轻缺血/再灌注损伤(ischemia-reperfusion injury,L/R)和全身炎症反应、防治肺动脉高压、合理的呼吸机通气管理等,希望有助于肝移植术后肺部并发症的防治,促进肝移植病人预后.
간이식술후폐부병발증적발생솔비상고,포괄폐불장、흉강적액、폐수종、폐부감염화급성호흡쇠갈등,엄중영향병인적예후.인기간이식술후폐부병발증적인소흔다,주요포괄수술조작、감염、순배용량초부하、수혈상관적급성폐손상、결혈/재관주、호흡궤상관성폐손상、간폐종합정화문폐고압증등인소,이차위의거,현제출료구체적방치조시,포괄완선적술전준비、방지용량초부하、합리수혈화혈제품,조절응혈공능,주의예방수혈상관적급성폐손상(transtnsion related acutte lung injury,TRALL)、합리응용억태매、감경결혈/재관주손상(ischemia-reperfusion injury,L/R)화전신염증반응、방치폐동맥고압、합리적호흡궤통기관리등,희망유조우간이식술후폐부병발증적방치,촉진간이식병인예후.
Pulmonary complications after orthotopic liver transplantation are frequent, involving high morbidity and mortality. In this article, the etiological factors and mechanism of pulmonary complications, especially acute lung injury and/or acute respiratory distress syndrome, were reviewed. Furthermore, we introduced some strategies of preventing and treating pulmonary complications, including perfect preoperative preparation, prevention of circulatory overload, minimum transfusion, usage of aprotinin and ulinastatin, administration of ventilation, and so on.