Early respiratory complications after liver transplantation
Early respiratory complications after liver transplantation
复制标题
DOI：
10.3748/wjg.v19.i48.9271
复制
发表时间：
2013-12-28
影响因子：
4.3
通讯作者：
Ori, Carlo
中科院分区：
文献类型：
--
作者：
Feltracco, Paolo;Carollo, Cristiana;Ori, Carlo
在终末期肝病模型评分较高的患者中，与终末期肝硬变相关的不良临床条件、既往存在的肺部异常以及高并发症发生率都是公认的增加原位肝移植(OLT)术后肺部并发症风险的因素。术中和术后的许多事件，如液体超载、大量输血、血液动力学不稳定、意外的凝血功能异常、肾功能障碍和再灌注综合征的严重不良反应，都是易患术后呼吸系统疾病的其他因素。尽管外科技术和麻醉管理有了进步，但在整个围手术期，肺仍可能遭受各种类型的损伤和呼吸机能障碍，具有不同的临床结果。肝移植术后肺部并发症可分为感染性和非感染性两类。胸腔积液、肺不张、肺水肿、呼吸窘迫综合征和肺炎可能是肝移植患者早期发病率和死亡率的重要因素。准确识别肺部疾病至关重要，因为感染性肺部并发症需要迅速和积极的治疗，以防止弥漫性肺损伤和演变为多系统器官衰竭的风险。本文讨论了易发生术后肺部并发症的最常见的围手术期因素，以及这些并发症在原位肝移植术后的早期临床表现及对患者预后的影响。(C)2013年白石登出版集团有限公司。版权所有。
The poor clinical conditions associated with end-stage cirrhosis, pre-existing pulmonary abnormalities, and high comorbidity rates in patients with high Model for End-Stage Liver Disease scores are all well-recognized factors that increase the risk of pulmonary complications after orthotopic liver transplantation (OLT) surgery. Many intraoperative and postoperative events, such as fluid overload, massive transfusion of blood products, hemodynamic instability, unexpected coagulation abnormalities, renal dysfunction, and serious adverse effects of reperfusion syndrome, are other factors that predispose an individual to postoperative respiratory disorders. Despite advances in surgical techniques and anesthesiological management, the lung may still suffer throughout the perioperative period from various types of injury and ventilatory impairment, with different clinical outcomes. Pulmonary complications after OLT can be classified as infectious or non-infectious. Pleural effusion, atelectasis, pulmonary edema, respiratory distress syndrome, and pneumonia may contribute considerably to early morbidity and mortality in liver transplant patients. It is of paramount importance to accurately identify lung disorders because infectious pulmonary complications warrant speedy and aggressive treatment to prevent diffuse lung injury and the risk of evolution into multisystem organ failure. This review discusses the most common perioperative factors that predispose an individual to postoperative pulmonary complications and these complications' early clinical manifestations after OLT and influence on patient outcome. (C) 2013 Baishideng Publishing Group Co., Limited. All rights reserved.