摘要
随着外科技术的发展,肝移植手术的适应证向病情复杂、严重的病人扩展,这些病人除肝功能处于终末期外,通常还合并其他重要肝外器官的功能损伤。肝移植术后早期肝外脏器功能管理策略有助于肝移植病人早期快速康复。本文就心、肺、肾、脑等重要肝外脏器在成人肝移植术后早期的管理策略作详细论述。术后继续进行血流动力学监测有助于维持供肝灌注,对前负荷、心肌收缩力及后负荷三个方面的评估管理非常重要。目前指南明确推荐术后早期拔管,对于术后肺部并发症的常规筛查有助于脱机。术后急性肾损伤的诊断遵循改善全球肾脏病预后组织(Kidney Disease:Improving Global Outcomes,KDIGO)的定义,肝移植术后早期延迟使用钙调磷酸酶抑制剂方案有利于肾功能保护。启动肾脏替代治疗的时机目前没有统一意见。肝硬化和肝性脑病病史会引起神经系统恢复受损,对肝性脑病正确诊断非常重要但很困难。
With the improvements in surgical technique,the indications for liver transplantation(LT)are being expanded to more complex and severe patients,who not only have liver function in the terminal stage,but also extrahepatic organs involve of varying degrees dysfunction.It was demonstrated that the strategy of extrahepatic organs management in early period after LT was associated with improving recovery.This paper summarized the strategy of extrahepatic organs management in early period after adult LT.Continuing to monitor system hemodynamics is helpful for stable graft perfusion.It is necessary to manage derangements of preload,myocardial contractility,and afterload.Early postoperative extubation is recommended by current guidelines.Routine screening pulmonary complications may help weaning from the ventilator.The diagnosis of acute kidney injury(AKI)after LT has been reported to using Kidney Disease:Improving Global Outcomes(KDIGO)criteria,a delayed calcineurin inhibitor initiation strategy may be beneficial for renal protection.Currently,there is no consensus on timing of renal replacement therapy initiation in patients with AKI.Patients with cirrhosis and a history of hepatic encephalopathy(HE)displays impaired neurological recovery,the diagnosis of HE is crucial and challenging.
作者
邓羽霄
赵贤元
皋源
DENG Yuxiao;ZHAO Xianyuan;GAO Yuan(Department of Critical Care Medicine,Renji Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200127,China)
出处
《外科理论与实践》
2023年第5期415-419,共5页
Journal of Surgery Concepts & Practice
关键词
肝移植
肝外器官
重症监护
Liver transplantation
Extrahepatic organ
Intensive care
作者简介
通信作者:皋源,E-mail:rj_gaoyuan@163.com
