肝移植术后早期并发消化道瘘的护理  

Nursing of digestive tract fistula after orthotopic liver transplantation

作　　者：豆秋江[1] 罗新春[1] 叶海丹[1] 曾巧玲[1] 高丽[1] 陈公云[1] 

机构地区：[1]中山大学附属第一医院器官移植中心,广州510080

出　　处：《中国实用护理杂志》2012年第16期1-3,共3页Chinese Journal of Practical Nursing

基　　金：国家自然科学基金（30972951）;广东省科技计划项目基金（20088030301308）;广东省护理学会基金（A2009034）

摘　　要：目的总结肝移植术后早期并发消化道瘘的护理体会。方法2000年1月至2010年12月共完成1173例次尸体肝移植，61例术后早期并发消化道瘘。回顾性分析61例患者的临床资料及其护理要点。结果肝移植术后早期并发消化道瘘的发生率为5．20％。其中胆瘘发生率为3．90％，胃瘘为0．42％，十二指肠瘘为0．08％，空肠瘘为0．34％，回肠瘘为0．08％，横结肠瘘为0．34％。肝移植术后早期并发消化道瘘的时间为3～24d，临床表现有：发热，腹痛，腹胀，肠蠕动减弱，甚至发生感染性休克。实验室检查可出现白细胞计数升高或下降、肝酶学及总胆红素升高等。经保守或手术治疗后，4例胆瘘患者死亡，7例肠瘘患者死亡。其余50例康复出院。结论肝移植术后早期消化道瘘的发生率低，但死亡率高。密切观察患者的病情变化争取早期诊断，及时恰当处理，以有效提高肝移植并发消化道瘘的治疗效果。同时做好心理护理、基础护理、饮食护理等，提高患者的生存率和生活质量。Objective To summarize nursing experience of digestive tract fistula after orthotopic liv- er transplantation （OLT）. Methods From January 2000 to December 2010, 1173 patients received liver transplantation, among whom 61 recipients got digestive tract fistula during early stage after operation. The clinical data and major nursing measures of 61 patients were studied retrospectively. Results The inci- dence rate of digestive tract fistula after OLT was 5.20%. The incidence rate of bile leakage, gastric fistula, duodenal fistula, jejunal fistula, ileal fistula and transverse colon fistula were 3.90%, 0.42% , 0.08%, 0.34%, 0.08% and 0.34%, respectively. The onset time of digestive tract fistula was from 3 to 24 days post transplantation, and atypical symptoms such as fever, abdominal pain, abdominal distention, weakened ente- rocinesia and even septic shock were presented. And the rising or descending of white blood cells counts, rising of level of transaminase and total bilirubin in laboratory examination were simultaneously presented. Four patients died of bile leakage, and other seven patients died of intestinal fistula throughout conservative or operative treatment. The rest of 50 were discharged healthily. Conclusions The morbidity of digestive tract fistula after OLT is low, but its mortality rate is high. It is necessary to closely observe patients＇ condi- tion and confirm diagnosis in early stage, in order to promote the healing of digestive tract fistula after OLT. At the same time, psychological, basic and dietary nursing should be given in order to enhance the survival rate and quality of life of patients.

关 键 词：肝移植 消化道瘘 护理 

分 类 号：R473.6[医药卫生—护理学]