CAJ | 학술논문

目的：分析肝脏切除术中大出血患者预后不佳的危险因素，指导护理工作。方法采用回顾性研究方法，选取2008年1月-2012年12月在东方肝胆外科医院接受肝脏切除手术患者61例，根据不同结局将其分为死亡组与康复组，比较两组病例在围术期资料差异。结果单因素分析发现：在年龄、Child-Pugh 分级、手术时间、肝门阻断时间、术中输血量、转入 ICU 时 pH 及血红蛋白值、急性肾功能衰竭、机械通气时间超过4h 共9个方面，两组差异有统计学意义（P<0.05）。采用逐步回归行多因素分析发现：4个因素为肝脏切除术中大出血患者术后死亡的独立危险因素（P<0.05），即术中输血量>10000 mL、肝门阻断时间>35 min、转入ICU 时 pH<7.2，急性肾功能衰竭和机械通气>4 h。结论控制术中输血量、术中肝门阻断时间，控制患者转入 ICU 时的 pH 值、急性肾功能衰竭和机械通气时间，能降低肝脏切除术中大出血患者术后死亡的风险。提示对具有前述危险因素的患者，医护的团队合作特别重要，除了手术医生规避相应风险之外，护士应在手术日和术后1 d，严密监护患者生命体征、腹腔引流情况等，警惕腹腔出血先兆症状，早期汇报，及时二次手术等，均有利于提高该类患者术后的生存率。
목적：분석간장절제술중대출혈환자예후불가적위험인소，지도호리공작。방법채용회고성연구방법，선취2008년1월-2012년12월재동방간담외과의원접수간장절제수술환자61례，근거불동결국장기분위사망조여강복조，비교량조병례재위술기자료차이。결과단인소분석발현：재년령、Child-Pugh 분급、수술시간、간문조단시간、술중수혈량、전입 ICU 시 pH 급혈홍단백치、급성신공능쇠갈、궤계통기시간초과4h 공9개방면，량조차이유통계학의의（P<0.05）。채용축보회귀행다인소분석발현：4개인소위간장절제술중대출혈환자술후사망적독립위험인소（P<0.05），즉술중수혈량>10000 mL、간문조단시간>35 min、전입ICU 시 pH<7.2，급성신공능쇠갈화궤계통기>4 h。결론공제술중수혈량、술중간문조단시간，공제환자전입 ICU 시적 pH 치、급성신공능쇠갈화궤계통기시간，능강저간장절제술중대출혈환자술후사망적풍험。제시대구유전술위험인소적환자，의호적단대합작특별중요，제료수술의생규피상응풍험지외，호사응재수술일화술후1 d，엄밀감호환자생명체정、복강인류정황등，경척복강출혈선조증상，조기회보，급시이차수술등，균유리우제고해류환자술후적생존솔。
Objective To examine the risk factors of poor prognosis in massive bleeding during hepatectomy. Methods Sixty-one patients experienced massive hemorrhage were included death group including 22 deaths and survival group 39 recovered patients. The factors related to different prognostic results were compared by univariate and multivariate analysis. Results The analysis showed the risk factors included the amount of blood transfusion during the operation >10 000 mL, the Pringle maneuver time >35 minutes, pH<7.2 when transferred to ICU, acute kidney failure or the time of mechanical ventilation >4 hrs. Conclusion The nurses play an important role in the early postoperative period of high risk patients with massive intraoperative blood transfusion more than 10 000 mL, the Pringle maneuver time >35 minutes and pH<7.2 when transferred to ICU who need special nursing and closely monitoring. Guided by the surgeries and anesthetists, it is significant to stop the bleeding and restrict the crystal, regular monitoring the artery blood gas and withdraw the endotracheal tube as soon as possible. Early judgment and reporting for the second operation in time is beneficial to improving their postoperative survival rate.