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小儿活体肝移植围术期肺部并发症的总结
Perioperative pulmonary complications in 20 cases of pediatric liver transplantation
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DOI:
作者:
仇焕容,张梁,田鸣
QIU Huanrong, ZHANG Liang, TIAN Ming
作者单位:
首都医科大学附属北京友谊医院麻醉科
Department of Anesthesia, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
关键词:
活体肝移植 围术期肺部并发症 小儿
Living donor liver transplantation; Perioperative pulmonary complications; Pediatrics
摘要:
目的 分析小儿活体肝移植围术期肺部并发症的发生及其特点。方法 2014年7月至2015年4月我院行小儿活体肝移植手术20例,收集其临床资料。结果 20例患儿,年龄4~11月,其中术前合并肺部感染者14例,未合并肺部感染者6例,既往未行Kasai术的患儿术前肺部感染9/11例,行Kasai术的患儿术前肺部感染5/11例;术前合并肺部感染的患儿更容易并发肝性脑病以及白细胞计数升高(P=0.042,0.015)。与术前未合并肺部感染者相比,术前合并肺部感染患儿的手术时间延长约50min(P=0.049);术后7天内合并肺炎的患儿,其中,术前未合并肺部感染者为5/6例,术前合并肺部感染者为13/14例,术后7天至出院前期间合并肺炎的则分别为3/6例,9/14例。术后7天内仅出现1例肺不张,而术后7天至出院前期间有2例肺不张,1例气胸,1例呼吸衰竭,并行再次气管插管治疗。均顺利出院。结论 术前合并肺部感染的患儿更容易并发肝性脑病以及白细胞计数升高,且更容易出现术后肺部并发症,尤其是术后7天至出院前这段时间。
Objective: To summarize perioperative pulmonary complications in pediatric living donor liver transplantation (DLT). Methods: A retrospective study was made in 20 consecutive infant patients with DLT between 2014.7.1-2015.4.30 at our hospital. Results: The range age of pediatric patients was 4-11 months. Fourteen patients from 20 patients had combined with pulmonary abnormalities. Nine out of 11 patients without a Kasai operation had suffered from pulmonary abnormalities preoperatively, and five out of 11 patients with previous Kasai operation. It was more likely to occur the hepatic encephalopathy and elevating white blood cells counts in those patients with preoperative pulmonary abnormalities (P=0.042,0.015). Patients with preoperative pulmonary abnormalities had longer surgical time, about 50min, (P=0.049). 13/14 cases with pulmonary abnormalities preoperatively developed early postoperative respiratory complications (within 7 days), and 9/14 cases developed late postoperative respiratory complications (from postoperative 7th day to being discharged). Only one case of atelectasis occurred within postoperative 7 days. And two cases of atelectasis, one case of pneumothorax, and one case of respiratory failure occurred after postoperative 7th day. Conclusion: Patients with preoperative pulmonary abnormalities were more likely to suffer from hepatic encephalopathy and elevating white blood cells counts, and developed postoperative pulmonary complications. We still need to focus on the management of pulmonary complications, especially one week after operation.
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