持续性血液净化治疗肝移植术后高渗血症伴神志障碍的研究  

Role of continuous blood purification on treatment of hyperosmosis with unconsciousness after liver transplantation

作　　者：易慧敏[1] 汪根树[1] 易述红[1] 陈颖华[1] 蔡常洁[1] 杨扬[1] 陆敏强[1] 陈规划[1] 

机构地区：[1]中山大学附属第三医院肝移植中心,广州510630

出　　处：《中华普通外科学文献（电子版）》2009年第5期38-40,共3页Chinese Archives of General Surgery(Electronic Edition)

基　　金：国家重点基础研究发展计划(973课题)资助项目(2003CD515507);广东省科技计划资助项目(2008B060600060);广东省卫生厅(A2007206)

摘　　要：目的探讨持续性血液净化(CBP)对肝移植术后高渗血症伴神志障碍患者稳定水、电解质平衡和降低血渗透压,阻止代谢性脑病发生和发展的治疗作⒚。方法回顾性分析肝移植术后高渗血症伴神志障碍患者24例的临床资料,其中10例仅给予降低血渗透压的保守治疗(保守治疗组),14例给㈣CBP治疗(CBP组)。结果保守治疗组4例患者高渗血症得以纠正,神志改善。CBP组14例高渗血症均得以纠正,血钠、血尿素氮(BUN)、肌酐水平降至正常;神志恢复清醒者11例(78.6%),GLASGOW评分均改善为14～15分;神志无好转者3例(21.4%)。多因继发肺部感染、MODS而预后不佳。结论在肝移植术后高渗血症伴神志障碍患者中,CBP治疗可有效纠正高渗血症,维持水电解质平衡,改善由于高渗血症导致的神志障碍,减少并发症,提高肝Σ植术后生存率。Objective To investigate the role of continuous blood purification（CBP） on treatment of hyperosmosis with unconsciousness after liver transplantation. Methods Twenty-four cases of post liver transplantation patients with hyperosmosis and unconsciousness were retrospectively analyzed. Ten patients were treated by conventional method including hypoosmotic fluid infusion and positive balance of fluid （conventional group）. Forteen patients were treated with CBP（CBP group）. Results The hyperosmosis and unconsciousness of 4 patients were cured in conventional group. The hyperosmosis of all patients in CBP group was normalized with the decrease of serum sodium, BUN and cfitinine to normal level. And 11 （78.6%） patients waked after the treatment of CBP. The GLASGOW score was improved to 14-15. The patients who were still unconscious were complicated with pulmonary infection or MODS and the prognosis were poor. Conclusion CBP may cure the hyperosmosis with unconsciousness in liver transplantation patients by the normalization of serum osmotic pressure and electrolyte balance to improve the prognosis of liver transplantation.

关 键 词：肝移植 脑病 代谢性 血液透析滤过 高渗血症 

分 类 号：R657.3[医药卫生—外科学]