| 摘要: |
| 目的:分析终末期肝硬化患者肝移植术前严重低氧血症及肝肺综合征(hepatopulmonary syndrome,HPS)发生情况,筛选相关危险因素,为临床围手术期麻醉管理提供依据。方法:回顾性分析2001年5月至2005年9月间长征医院行肝移植术治疗的214例终末期肝硬化患者的临床资料,分析其肝移植术前的氧合情况;以肺泡-动脉氧分压差(AaPO2)>20 mmHg(1 mmHg=0.133 kPa)、PaO2<70 mmHg为标准,筛选严重低氧血症及HPS的相关危险因素;分析术前PaO2与术后机械通气时间、ICU停留时间的相关性。结果:214例肝硬化患者术前常伴随低氧血症。PaO2与Child分级、胸水有无、总胆红素、血氨、乳酸相关(相关系数r=-0.22、-0.16、-0.17、0.20、-0.29);PaCO2与术前Hb、白蛋白水平直接相关(r=0.23、0.13)。AaPO2与肝掌、蜘蛛痣、Child分级无显著相关性;PaO2与Child分级显著相关,但与肝掌、蜘蛛痣无显著相关性。PaO2与术后机械通气时间和移植术后ICU停留时间呈负相关(r=-0.388 81,P=0.000 1;r=-0.176 84,P=0.010 4)。结论:终末期肝硬化患者常伴随严重低氧血症;低氧血症的发生与术前肝功能分级及相关因素有关,对术后机械通气时间及ICU停留时间有较大影响;终末期肝硬化患者肝移植术前应全面评估严重低氧血症、HPS发生情况,以利于围手术期采取相应处理。 |
| 关键词: 肝硬化 肝肺综合征 低氧血症 术后呼吸支持时间 ICU停留时间 |
| DOI：10.3724/SP.J.1008.2008.01426 |
| 投稿时间：2008-04-14修订日期：2008-11-04 |
| 基金项目:上海市卫生局科研基金(2006076). |
|
| Risk factors of hypoxaemia in patients with end-stage liver cirrhosis |
| MA Li1,SHI Xue-yin2*,ZOU Zui2,XU Hai-tao2,YUAN Hong-bin2,FU Zhi-ren3,shixueyin |
| (1.Department of Anaesthesia,General Hospital,PLA Beijing Military Area Command,Beijing 100700,China*2.Department of Anaesthesia,Changzheng Hospital,Second Military Medical University,Shanghai 200003*3.Department of Organ Transplantation,Changzheng Hospital,Second Military Medical University,Shanghai 200003) |
| Abstract: |
| Objective:To screen for risk factors for hypoxaemia and heptopulmonary syndrome (HPS) in patients with end-stage liver diseases by analyzing the preoperative incidence of HPS,so as to provide evidence for anaesthesia management during the perioperative peroid.Methods: The clinical data of 214 patients with liver cirrhosis,who received liver transplantation from May 2001 to Sep. 2005 in Changzheng Hospital,were retrospectively investigated.The statistical package of SAS 6.12 was used to analyze the state of oxygenation.The standard of hypoxaemia and HPS was AaPO2>20 mmHg(1 mmHg=0.133 kPa)and PaO2<70 mmHg.The correlation of PaO2 with duration of mechanical ventilation and intensive care unit (ICU) stay was analyzed.Results: It was showed that the 214 patients often suffered from hypoxaemia.PaO2 was found correlated with Child-Pugh classification,hydrothorax,total bilirubin,ammonia,and lactic acid,with the values of r being -0.22,-0.16,-0.17,0.20,and -0.29,respectively.PaCO2 was correlated with haemoglobin and serum albumin,with the values of r being 0.23 and 0.13,repectively.AaPO2was not correlated with spider naevi,liver palms or Child-Pugh class; PaO2 was not correlated with spider naevi or liver palms.PaO2 was negatively correlated with the duration of mechanical ventilation and ICU stay (r=-0.388 81,P=0.000 1;r=-0.176 84,P=0.010 4).Conclusion: Patients with liver cirrhosis often suffer from hypoxaemia; the incidence of hypoxaemia is correlated with preoperative liver function classification and other related factors,and has great influence on duration of technical ventilation and ICU stay.The incidence of hypoxaemia and HPS should be evaluated before liver transplantation in patients with end-stage liver cirrhosis,so as to benefit perioperative management. |
| Key words: liver cirrhosis hepatopulmonary syndrome hypoxaemia periods of mechanical ventilation ICU stay |
