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肝移植术后慢性低钠血症的临床研究

隋雨荧 于立新 邓文锋 周杰 刘如敏 苗芸

隋雨荧, 于立新, 邓文锋, 等. 肝移植术后慢性低钠血症的临床研究[J]. 器官移植, 2017, 8(1): 44-48. doi: 10.3969/j.issn.1674-7445.2017.01.009
引用本文: 隋雨荧, 于立新, 邓文锋, 等. 肝移植术后慢性低钠血症的临床研究[J]. 器官移植, 2017, 8(1): 44-48. doi: 10.3969/j.issn.1674-7445.2017.01.009
Sui Yuying, Yu Lixin, Deng Wenfeng, et al. Clinical study of chronic hyponatremia after liver transplantation[J]. ORGAN TRANSPLANTATION, 2017, 8(1): 44-48. doi: 10.3969/j.issn.1674-7445.2017.01.009
Citation: Sui Yuying, Yu Lixin, Deng Wenfeng, et al. Clinical study of chronic hyponatremia after liver transplantation[J]. ORGAN TRANSPLANTATION, 2017, 8(1): 44-48. doi: 10.3969/j.issn.1674-7445.2017.01.009

肝移植术后慢性低钠血症的临床研究

doi: 10.3969/j.issn.1674-7445.2017.01.009
基金项目: 

国家自然科学基金 81500573

南方医科大学南方医院院长基金 2013B011

南方医科大学南方医院院级教育课题 14NJ-ZL01

详细信息
    通讯作者:

    苗芸,Email:miaoyunecho@126.com

  • 中图分类号: R617, R619+.4

Clinical study of chronic hyponatremia after liver transplantation

More Information
  • 摘要:   目的  总结肝移植术后慢性低钠血症的特点和防治方法。  方法  回顾性分析肝移植术后发生慢性低钠血症的26例患者的临床资料。记录患者的一般情况和主要并发症;对肝移植术后住院时间和低钠血症持续时间进行相关性分析;总结患者的治疗和转归。  结果  26例患者的血钠浓度中位数为131 mmol/L(125~133 mmol/L),均为轻、中度低钠血症。其他主要并发症包括肺部感染(13例,50%)、移植肝急性排斥反应(7例,27%)和消化道出血(7例,27%)。患者肝移植术后住院时间与低钠血症持续时间具有相关性。治疗方法为对患者病情充分评估,去除诱因,通过胃肠道和(或) 静脉补给3%高渗盐水。经积极治疗后,治愈23例(88%),3例(12%)死于感染合并多器官功能衰竭。  结论  肝移植术后慢性低钠血症发生率低、程度较轻,且患者住院时间与低钠血症持续时间有相关性。治疗关键在于及时去除病因,依据个体化原则纠正低钠状态,积极防治并发症。

     

  • 图  1  肝移植术后发生慢性低钠血症患者的主要并发症种类及发生率

    Figure  1.  The varieties and incidence rates of main complications in patients with hyponatremia after liver transplantation

    图  2  肝移植术后慢性低钠血症持续时间与术后住院时间的相关性

    Figure  2.  The relevance between duration of hyponatremia and length of hospital stay after liver transplantation

  • [1] 格林伯格著德.神经外科手册[M]. 7版.南京:江苏科学技术出版社, 2013.
    [2] Wang P, Huang G, Tam N, et al. Influence of preoperative sodium concentration on outcome of patients with hepatitis B virus cirrhosis after liver transplantation[J]. Eur J Gastroenterol Hepatol, 2016, 28(10):1210-1215. DOI: 10.1097/MEG.0000000000000690.
    [3] 于学忠.协和急诊医学[M].北京:科学出版社, 2011.
    [4] 王小文, 李宁, 陈大志, 等.肝移植术后的低钠血症[J].中华器官移植杂志, 2005, 26(1): 9-10. DOI: 10.3760/ cma.j.issn.0254-1785.2005.01.003.

    Wang XW, Li N, Chen DZ, et al. Hyponatremia after liver transplantation[J]. Chin J Organ Transplant, 2005, 26(1):9-10.DOI:10.3760/cma.j.issn. 0254-1785.2005.01.003.
    [5] Hudcova J, Ruthazer R, Bonney I, et al. Sodium homeostasis during liver transplantation and correlation with outcomes[J]. Anesth Analg, 2014, 119(6):1420-1428. DOI: 10.1213/ANE.0000000000000415.
    [6] Pillai BP, Unnikrishnan AG, Pavithran PV. Syndrome of inappropriate antidiuretic hormone secretion: revisiting a classical endocrine disorder[J]. Indian J Endocrinol Metab, 2011, 15(Suppl 3):S208-S215. DOI: 10.4103/2230-8210.84870.
    [7] Peri A, Giuliani C. Management of euvolemic hyponatremia attributed to SIADH in the hospital setting[J]. Minerva Endocrinol, 2014, 39(1):33-41.
    [8] Braconnier A, Vrigneaud L, Bertocchio J P. Hyponatremias: from pathophysiology to treatments. review for clinicians[J]. Nephrol Ther, 2015, 11(4):201-212. DOI: 10.1016/j.nephro.2015.04.002.
    [9] Berchtold L, Martin P Y, Ponte B. Diagnosis and management of hyponatremia: review of current recommendations[J]. Praxis, 2015, 104(7):341-347. DOI: 10.1024/1661-8157/a001961.
    [10] Dick M, Catford S R, Kumareswaran K, et al. Persistent syndrome of inappropriate antidiuretic hormone secretion following traumatic brain injury[J]. Endocrinol Diabetes Metab Case Rep, 2015: 150070. DOI: 10.1530/EDM-15-0070.
    [11] Doherty Gerard M.外科学(英文版)[M].北京:北京大学医学出版社, 2016.
    [12] Lee J, Kim D K, Lee J W, et al. Rapid correction rate of hyponatremia as an independent risk factor for neurological complication following liver transplantation[J]. Tohoku J Exp Med, 2013, 229(2):97-105. doi: 10.1620/tjem.229.97
    [13] Angeli P, Sanyal A, Moller S, et al. Current limits and future challenges in the management of renal dysfunction in patients with cirrhosis: report from the International Club of Ascites[J]. Liver Int, 2013, 33(1):16-23. DOI: 10.1111/j.1478-3231.2012.02807.x.
    [14] Nair SR, Ramli NM, Rahmat K, et al. Central pontine and extrapontine myelinolysis: diffusion weighted imaging and diffusion tensor imaging on follow-up[J]. Neurol India, 2012, 60(4):426-428. DOI: 10.4103/0028-3886.100712.
    [15] Sinha VK, Ko B. Hyponatremia in cirrhosis--pathogenesis, treatment, and prognostic significance[J]. Adv Chronic Kidney Dis, 2015, 22(5):361-367. DOI: 10.1053/j.ackd.2015.02.002.
    [16] Gianotti RJ, Cardenas A. Hyponatraemia and cirrhosis[J]. Gastroenterol Rep, 2014, 2(1):21-26. DOI: 10.1093/gastro/got037.
    [17] Li C, Wen TF, Yan LN, et al. Risk factors for in-hospital mortality of patients with high model for end-stage liver disease scores following living donor liver transplantation[J]. Ann Hepatol, 2012, 11(4):471-477.
    [18] Cimen S, Guler S, Ayloo S, et al. Implications of hyponatremia in liver transplantation[J]. J Clin Med, 2014, 4(1):66-74. DOI: 10.3390/jcm4010066.
    [19] Moini M, Hoseini-Asl MK, Taghavi SA, et al. Hyponatremia a valuable predictor of early mortality in patients with cirrhosis listed for liver transplantation[J]. Clin Transplant, 2011, 25(4):638-645. DOI: 10.1111/j.1399-0012.2010.01350.x.
    [20] Sharma P, Schaubel DE, Goodrich NP, et al. Serum sodium and survival benefit of liver transplantation[J]. Liver Transpl, 2015, 21(3):308-313. DOI: 10.1002/lt.24063.
    [21] Lizaola B, Bonder A, Tapper E B, et al. The changing role of sodium management in cirrhosis[J]. Curr Treat Options Gastroenterol, 2016, 14(2):274-284. DOI: 10.1007/s11938-016-0094-y.
    [22] Romanovsky A, Azevedo LC, Meeberg G, et al. Serum sodium shift in hyponatremic patients undergoing liver transplantation: a retrospective cohort study[J]. Ren Fail, 2015, 37(1):37-44. DOI: 10.3109/0886022X.2014.975102.
    [23] Karapanagiotou A, Kydona C, Papadopoulos S, et al. The effect of hyponatremia on the outcome of patients after orthotopic liver transplantation[J]. Transplant Proc, 2012, 44(9):2724-2726. DOI: 10.1016/j.transproceed.2012.09.095.
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出版历程
  • 收稿日期:  2016-09-30
  • 网络出版日期:  2021-01-19
  • 刊出日期:  2017-01-15

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