小儿活体肝移植围术期肺部并发症的回顾性分析

发布时间：2018-12-23 11:06

【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1日—2015年4月30日行择期小儿活体肝移植手术的患儿20例,男8例,女12例,手术诊断均为胆道闭锁。复习病历资料,收集其术前、术中和术后相关临床资料进行总结,包括患儿的基本资料(年龄、性别、身高、体重等)、住院天数、术前合并症和疾病的严重程度、术前和术后肺部的异常情况、辅助检查结果、手术和麻醉情况、术后肺部并发症等。结果 20例患儿,年龄4~11个月,美国麻醉医师协会分级Ⅲ或Ⅳ级。术前合并肺部感染14例,未合并肺部感染6例。术前合并肺部感染的患儿中,行Kasai手术5例;术前未合并肺部感染的患儿中,行Kasai手术4例。术前合并肺部感染患儿的肝性脑病构成比、白细胞计数显著高于未合并肺部感染患儿(P=0.042、0.015)。术前合并肺部感染患儿的手术时间为(384.6±81.7)min,显著长于术前未合并肺部感染患儿的(334.2±22.9)min(P=0.049)。术前合并肺部感染的患儿术后7d内合并肺部感染13例,术后7d后至出院前合并肺部感染9例,术前未合并肺部感染的患儿分别为5例和3例,两者间差异均无统计学意义(P值均0.05)。术后7d内出现肺不张1例(为术前合并肺部感染患儿),未出现胸腔积液、气胸和呼吸衰竭。术后7d后至出院前,术前合并肺部感染患儿出现肺不张2例、胸腔积液2例、气胸1例、呼吸衰竭1例;术前未合并肺部感染患儿仅发生肺不张1例。结论术前合并肺部感染的患儿更容易并发肝性脑病和白细胞计数升高,且可能于术后7d至出院前发生肺不张、胸腔积液、气胸和呼吸衰竭等较严重的并发症。
[Abstract]:Objective to analyze the occurrence and characteristics of perioperative pulmonary complications in children with live liver transplantation. Methods from July 1, 2014 to April 30, 2015, 20 children (8 males and 12 females) underwent elective liver transplantation in children, all of whom were diagnosed as biliary atresia. Reviewing the medical records, collecting the clinical data before, during and after operation, including the basic data of the children (age, sex, height, weight, etc.), the days of hospitalization, the severity of complications and diseases before operation, Preoperative and postoperative pulmonary abnormalities, auxiliary findings, surgical and anesthetic conditions, postoperative pulmonary complications, etc. Results 20 cases, aged 4 ~ 11 months, were classified as 鈪，

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