CAJ | 학술논문

目的:探讨肝硬化门静脉高压患者行脾切除+贲门周围血管离断术后持续发热的危险因素及处理方法,以为临床提供指导.方法:收集本院2005年1月~2012年5收治肝硬化门静脉高压行脾切除+贲门周围血管离断术治疗的患者236例的临床资料,筛选术后持续性发热患者,比较分析术后持续性发热的危险因素,并总结处理方法.结果:本组236例患者,术后出现持续性发热35例,主要原因为感染22例,脾静脉血栓5例,原因不明8例.经对症处理后,痊愈32例,死亡3例,死亡原因为感染伴肝肾功能衰竭1例,重症肺炎1例,脾静脉血栓1例.单因素分析显示急诊手术、肝功能分级差、手术时间>4h、术后未进行全肠外营养、术后血小板明显升高是引起患者持续发热的主要危险因素(均P<0.05),而发热与患者性别年龄无明显关系.结论:脾切除+贲门周围血管离断术后持续发热的原因复杂,临床应根据发热危险因素,严格筛选可手术者,围术期有效抗感染,增强患者营养状态,尽量缩短手术时间,以有效减少术后持续发热.
목적:탐토간경화문정맥고압환자행비절제+분문주위혈관리단술후지속발열적위험인소급처리방법,이위림상제공지도.방법:수집본원2005년1월~2012년5수치간경화문정맥고압행비절제+분문주위혈관리단술치료적환자236례적림상자료,사선술후지속성발열환자,비교분석술후지속성발열적위험인소,병총결처리방법.결과:본조236례환자,술후출현지속성발열35례,주요원인위감염22례,비정맥혈전5례,원인불명8례.경대증처리후,전유32례,사망3례,사망원인위감염반간신공능쇠갈1례,중증폐염1례,비정맥혈전1례.단인소분석현시급진수술、간공능분급차、수술시간>4h、술후미진행전장외영양、술후혈소판명현승고시인기환자지속발열적주요위험인소(균P<0.05),이발열여환자성별년령무명현관계.결론:비절제+분문주위혈관리단술후지속발열적원인복잡,림상응근거발열위험인소,엄격사선가수술자,위술기유효항감염,증강환자영양상태,진량축단수술시간,이유효감소술후지속발열.
@@@@Objective: To investigate patients with portal hypertension underwent splenectomy pericardial blood vessel broken postoperative persistent fever risk factors and treatment methods that clinical guidance. Methods:Collect hospital in January 2005~2012 5 treated patients with portal hypertension splenectomy the+cardia surrounding blood vessels from the off surgery in patients treated 236 cases of clinical data, screening of patients with postoperative persistent fever, a comparative analysis of persistent postoperative fever of risk factors, and summarizes the approach. Results:Of the 236 cases of patients with persistent fever after 35 cases, mainly due to the infection in 22 cases, five cases of splenic vein thrombosis, unexplained eight cases. After symptomatic treatment, 32 cases recovered, 3 cases of death, cause of death was infection with liver and kidney function failure in 1 case, 1 cases of severe pneumonia, splenic vein thrombosis cases. Univariate analysis, display emergency surgery, classification of poor liver function, operative time>4h after surgery is not for total parenteral nutrition, postoperative platelet significantly higher in the major risk factors that cause patients with persistent fever (P<0.05). fever was no significant relationship with the patient sex and age. Conclusion: Splenectomy+pericardial blood vessel transection of postoperative persistent fever because complex clinical risk factors should be based on the heat, a rigorous screening can be surgery, perioperative anti-infection effective to enhance the nutritional status of patients, as far as possible to shorten the operation time to effectively reduce the persistent postoperative fever.