中华器官移植杂志
中華器官移植雜誌
중화기관이식잡지
CHINESE JOURNAL OF ORGAN TRANSPLANTATION
2013年
5期
290-293
,共4页
曾强%苑晓烨%赵鑫%曹经琳%高庆军%窦剑
曾彊%苑曉燁%趙鑫%曹經琳%高慶軍%竇劍
증강%원효엽%조흠%조경림%고경군%두검
肝移植%肺水肿%中心静脉压
肝移植%肺水腫%中心靜脈壓
간이식%폐수종%중심정맥압
Liver transplantation%Pulmonary edema%Central venous pressure
目的 探讨肝移植受者术后早期肺血容量过高的原因及相应的处理.方法 291例肝移植受者,35例术后早期出现不同程度的肺血容量增高而发生肺水肿(高肺血容量组),其余未出现肺血容量增高的256例为对照组.记录两组术前、术中和术后中心静脉压(CVP)以及术中和术后3d的总入量、总出量和液体平衡量.结果 高肺血容量组术前即存在循环血容量过高的情况.术前、术中和术后CVP分别为(12.33±5.08)、(14.33±3.03)和(16.50±4.57)mm Hg(1 mm Hg=0.133 kPa),均明显高于对照组的(7.10±2.62)、(4.33±0.33)和(5.28±2.33)mm Hg,差异均有统计学意义(P＜0.05).高肺血容量组术中及术后3d液体总入量、术中总出量和术后3d液体平衡量分别为(15 456±1 771)ml、(16 087±3 412)ml、(9 155±2 188)ml和(4 197±2 083)ml,均明显高于对照组(6 774±1 088)ml、(10 755±242)ml、(3 431±1 621)ml和(271±1 450)ml,差异均有统计学意义(P＜0.05).经利尿和血液滤过等治疗,高肺血容量组30例好转,3例感染鲍曼不动杆菌,2例感染真菌,均于术后1个月内死亡.结论 肝移植术后早期肺血容量过高与术前存在循环血容量过高、术中大量输血和输液以及术后补液控制不够等密切相关,因此术前、术中及术后液体进出量的合理控制是关键.
目的 探討肝移植受者術後早期肺血容量過高的原因及相應的處理.方法 291例肝移植受者,35例術後早期齣現不同程度的肺血容量增高而髮生肺水腫(高肺血容量組),其餘未齣現肺血容量增高的256例為對照組.記錄兩組術前、術中和術後中心靜脈壓(CVP)以及術中和術後3d的總入量、總齣量和液體平衡量.結果 高肺血容量組術前即存在循環血容量過高的情況.術前、術中和術後CVP分彆為(12.33±5.08)、(14.33±3.03)和(16.50±4.57)mm Hg(1 mm Hg=0.133 kPa),均明顯高于對照組的(7.10±2.62)、(4.33±0.33)和(5.28±2.33)mm Hg,差異均有統計學意義(P＜0.05).高肺血容量組術中及術後3d液體總入量、術中總齣量和術後3d液體平衡量分彆為(15 456±1 771)ml、(16 087±3 412)ml、(9 155±2 188)ml和(4 197±2 083)ml,均明顯高于對照組(6 774±1 088)ml、(10 755±242)ml、(3 431±1 621)ml和(271±1 450)ml,差異均有統計學意義(P＜0.05).經利尿和血液濾過等治療,高肺血容量組30例好轉,3例感染鮑曼不動桿菌,2例感染真菌,均于術後1箇月內死亡.結論 肝移植術後早期肺血容量過高與術前存在循環血容量過高、術中大量輸血和輸液以及術後補液控製不夠等密切相關,因此術前、術中及術後液體進齣量的閤理控製是關鍵.
목적 탐토간이식수자술후조기폐혈용량과고적원인급상응적처리.방법 291례간이식수자,35례술후조기출현불동정도적폐혈용량증고이발생폐수종(고폐혈용량조),기여미출현폐혈용량증고적256례위대조조.기록량조술전、술중화술후중심정맥압(CVP)이급술중화술후3d적총입량、총출량화액체평형량.결과 고폐혈용량조술전즉존재순배혈용량과고적정황.술전、술중화술후CVP분별위(12.33±5.08)、(14.33±3.03)화(16.50±4.57)mm Hg(1 mm Hg=0.133 kPa),균명현고우대조조적(7.10±2.62)、(4.33±0.33)화(5.28±2.33)mm Hg,차이균유통계학의의(P＜0.05).고폐혈용량조술중급술후3d액체총입량、술중총출량화술후3d액체평형량분별위(15 456±1 771)ml、(16 087±3 412)ml、(9 155±2 188)ml화(4 197±2 083)ml,균명현고우대조조(6 774±1 088)ml、(10 755±242)ml、(3 431±1 621)ml화(271±1 450)ml,차이균유통계학의의(P＜0.05).경이뇨화혈액려과등치료,고폐혈용량조30례호전,3례감염포만불동간균,2례감염진균,균우술후1개월내사망.결론 간이식술후조기폐혈용량과고여술전존재순배혈용량과고、술중대량수혈화수액이급술후보액공제불구등밀절상관,인차술전、술중급술후액체진출량적합리공제시관건.
Objective Objective To explore the reasons of lung hypervolemia after liver transplantation and the corresponding treatment strategies.Method 291 patients received liver transplantation,in which 35 cases underwent pulmonary edema at early stage (pulmonary hypervolemia group),and the rest without pulmonary hypervolemia served as control group.Average central venous pressure (CVP) was recorded pre-,intra-and post-operatively.Total intake,total discharge and fluid balance were also recorded intraoperatively and 3 days post-operatively.Result In pulmonary hypervolemia group,CVP was (12.33 ± 5.08),(14.33 ± 3.03) and (16.50 ± 4.57) mmHg pre-,intra-and post-operatively,significantly higher than that in control group (P＜0.05 for all).Total intake,total discharge and fluid balance in pulmonary hypervolemia group were significantly higher than those in control group intraoperatively and 3 days post-operatively (P＜0.05 for all).After diuretic therapy and hemodialysis,30 cases in pulmonary hypervolemia group recurred,and 5 cases died of infection.Conclusion Pulmonary hypervolemia at early stage after liver transplantation is related to fluid balance.The reasonable control of total intake,total discharge and fluid balance is necessary.
