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肝移植治疗肝昏迷的围手术期管理经验探讨

刘焕业 寇建涛 马军 朱继巧 杨龙 刘子希 李先亮 贺强

刘焕业, 寇建涛, 马军, 等. 肝移植治疗肝昏迷的围手术期管理经验探讨[J]. 器官移植, 2019, 10(3): 323-327. doi: 10.3969/j.issn.1674-7445.2019.03.017
引用本文: 刘焕业, 寇建涛, 马军, 等. 肝移植治疗肝昏迷的围手术期管理经验探讨[J]. 器官移植, 2019, 10(3): 323-327. doi: 10.3969/j.issn.1674-7445.2019.03.017
Liu Huanye, Kou Jiantao, Ma Jun, et al. Experience in perioperative management of liver transplantation in hepatic coma patients[J]. ORGAN TRANSPLANTATION, 2019, 10(3): 323-327. doi: 10.3969/j.issn.1674-7445.2019.03.017
Citation: Liu Huanye, Kou Jiantao, Ma Jun, et al. Experience in perioperative management of liver transplantation in hepatic coma patients[J]. ORGAN TRANSPLANTATION, 2019, 10(3): 323-327. doi: 10.3969/j.issn.1674-7445.2019.03.017

肝移植治疗肝昏迷的围手术期管理经验探讨

doi: 10.3969/j.issn.1674-7445.2019.03.017
基金项目: 

国家自然科学基金 81273270

国家自然科学基金 81471590

国家自然科学基金 81571554

刘焕业、寇建涛为共同第一作者
详细信息
    作者简介:

    刘焕业,男,1990年生,硕士,住院医师,研究方向为器官移植诱导免疫耐受,Email:liuhuanye_doc@163.com

    寇建涛,男,1973年生,博士,副主任医师,研究方向为器官移植,Email:koujt@medmail.com.cn

    通讯作者:

    李先亮,男,1971年生,博士,副主任医师,研究方向为器官移植诱导免疫耐受,Email:lixianliangbjcy@126.com

    贺强,男,1964年生,博士,主任医师,研究方向为器官移植诱导免疫耐受,Email:heqiang349@sina.com

  • 中图分类号: R617, R575.3

Experience in perioperative management of liver transplantation in hepatic coma patients

More Information
  • 摘要:   目的  分析肝移植治疗肝昏迷受者的疗效并总结围手术期管理的临床经验。  方法  回顾性分析行肝移植治疗的22例肝昏迷患者的临床资料。观察受者的围手术期情况, 包括手术时间、供肝热缺血时间、冷缺血时间、术中受体无肝期、术中出血量、术中输血量,术后早期血药浓度,术后并发症发生情况。对受者生存情况以及预后影响因素进行分析。  结果  22例受者的手术时间为8(6~12)h,供肝热缺血时间为4(2~6)min,冷缺血时间为7(5~10)h,术中受体无肝期为80(55~120)min,术中出血量为1 139(400~4 000)mL,术中输血量为1 440(0~3 600)mL。受者术后1周左右他克莫司(FK506)血药浓度波动于6~11 ng/mL。术后6例受者死亡,死亡原因分别为原发性移植肝无功能1例、严重感染2例、脑出血引起严重脑水肿1例、多器官功能衰竭2例。肝昏迷受者移植术后1个月和1年的生存率为82%和77%。  结论  肝移植能够显著提高肝昏迷受者的生存率。术前降血氨、术后控制感染、改善肾功能以及根据免疫状态制定精准个体化免疫抑制方案是提高生存率的关键。

     

  • 图  1  肝昏迷受者肝移植术后FK506血药谷浓度

    Figure  1.  The blood valley concentration of FK506 in patients with hepatic coma after liver transplantation

    图  2  肝昏迷受者肝移植术后的生存曲线

    Figure  2.  The survival graph of patients with hepatic coma after liver transplantation

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出版历程
  • 收稿日期:  2019-02-18
  • 网络出版日期:  2021-01-19
  • 刊出日期:  2019-05-15

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