肝移植术后慢性低钠血症的临床研究  

Clinical study of chronic hyponatremia after liver transplantation

作　　者：隋雨荧 于立新[2] 邓文锋[2] 周杰[3] 刘如敏[2] 苗芸[2] Sui Yuying Yu Lixin Deng Wenfeng Zhou Jie Liu Rumin Miao Yun(Eight-year MD-PhD Program, Southern Medical University, Guangzhou 510515, China)

机构地区：[1]南方医科大学,广州510515 [2]南方医科大学南方医院器官移植科 [3]南方医科大学南方医院肝胆外科

出　　处：《器官移植》2017年第1期44-48,共5页Organ Transplantation

基　　金：国家自然科学基金(81500573);南方医科大学南方医院院长基金(2013B011);南方医科大学南方医院院级教育课题(14NJ-ZL01)

摘　　要：目的总结肝移植术后慢性低钠血症的特点和防治方法。方法回顾性分析肝移植术后发生慢性低钠血症的26例患者的临床资料。记录患者的一般情况和主要并发症;对肝移植术后住院时间和低钠血症持续时间进行相关性分析;总结患者的治疗和转归。结果 26例患者的血钠浓度中位数为131 mmol/L(125~133 mmol/L),均为轻、中度低钠血症。其他主要并发症包括肺部感染(13例,50%)、移植肝急性排斥反应(7例,27%)和消化道出血(7例,27%)。患者肝移植术后住院时间与低钠血症持续时间具有相关性。治疗方法为对患者病情充分评估,去除诱因,通过胃肠道和(或)静脉补给3%高渗盐水。经积极治疗后,治愈23例(88%),3例(12%)死于感染合并多器官功能衰竭。结论肝移植术后慢性低钠血症发生率低、程度较轻,且患者住院时间与低钠血症持续时间有相关性。治疗关键在于及时去除病因,依据个体化原则纠正低钠状态,积极防治并发症。Objective To summarize clinical characteristics, prevention and treatment of postoperative chronic hyponatremia after liver transplantation（LT）. Methods Clinical data of 26 patients presenting with chronic hyponatremia after LT were retrospectively analyzed. Baseline data and main complications of patients with hyponatremia after LT were recorded. The correlation between postoperative length of hospital stay and the duration of hyponatremia was analyzed. Clinical treatment and prognosis were summarized. Results Among 26 patients, the median blood sodium concentration was 131 mmol/L （range 125 to 133 mmol/L）. All patients were diagnosed with mild or moderate degree of hyponatremia. Main complications included pulmonary infection （n=13, 50%）, acute rejection of liver graft （n=7, 27%） and digestive tract hemorrhage （n=7, 27%）. Postoperative length of hospital stay was correlated with the duration of hyponatremia. After full evaluation of patient＇s condition and excluding the potential inducers, a portion of 3% of hypertonic saline was administered via gastro-intestinal tract and/or vein. After positive treatment, 23 cases （88%） were healed and 3 （12%） died from infection complicated with muhiple organ failure. Conclusions After LT, the incidence of chronic hyponatremia is low with mild severity. Postoperative length of hospital stay is correlated with the duration of hyponatremia. The key of treatment is to timely exclude the inducers, correct the low level of sodium based upon the individual principles and prevent the incidence of postoperative complications.

关 键 词：肝移植 低钠血症 慢性 肝功能 血钠浓度 住院时间 并发症 病因 治疗 高渗盐水 

分 类 号：R617[医药卫生—外科学] R619.4[医药卫生—临床医学]