数字减影血管造影引导下经鼻肠梗阻导管置入治疗肝移植术后腹腔间室综合征疗效观察  

Digital subtraction angiography guided transnasal ileus tube placement in management of abdominal compartment syndrome after liver transplantation

作　　者：王兴强[1] 刘懿禾[1] 王兵[1] 于立新[1] 张景晓 蔡金贞[1] Wang Xingqiang;Liu Yihe;Wang Bing;Yu Lixin;Zhang Jingxiao;Cai Jinzhen(Intensive Care Unit of Transplantation,Tianjin First Central Hospital,Tianjin Key Laboratory of Organ Transplantation,Tianjin 300192,China)

机构地区：[1]天津市第一中心医院移植重症监护室,天津市器官移植重点实验室,300192

出　　处：《中华肝胆外科杂志》2021年第4期262-265,共4页Chinese Journal of Hepatobiliary Surgery

基　　金：国家自然科学基金(81670600)。

摘　　要：目的探讨数字减影血管造影(DSA)引导下经鼻肠梗阻导管置入治疗肝移植术后腹腔间室综合征(ACS)的疗效。方法回顾性分析2015年1月至2019年12月天津市第一中心医院移植重症监护室收治的肝移植术后确诊为ACS的患者30例作为研究对象。依据减压方式将30例患者分为研究组和对照组,每组各15例。对照组采用常规腹腔减压治疗,研究组在腹腔减压基础上行DSA引导下经鼻留置肠梗阻导管减压治疗。比较两组患者治疗7 d后腹内压(IAP)变化、治疗有效率和移植肝功能变化。结果30例肝移植术后ACS患者中男性23例,女性7例,年龄(53.4±11.6)岁。与治疗前相比,研究组患者治疗后的IAP[(7.13±3.87)比(22.73±2.09)mmHg]、门静脉血流速度[(34.76±10.31)比(21.45±6.47)cm/s]、胆汁引流量[(198.43±19.94)比(80.72±9.52)ml/d]、ALT[(158.92±67.56)比(278.73±99.17)U/L]和AST[(79.36±15.63)比(196.71±89.05)U/L]均显著改善(P<0.05)。与对照组相比,研究组患者治疗后的IAP[(7.13±3.87)比(13.47±6.19)mmHg]、门静脉血流速度[(34.76±10.31)比(24.98±8.54)cm/s]、胆汁引流量[(198.43±19.94)比(108.73±21.30)ml/d]和TBil[(258.85±91.95)比(343.69±89.45)μmol/L]均有显著改善(P<0.05)。对照组在治疗后第4天IAP下降到和基线比较差异有统计学意义(P<0.05),研究组患者在治疗后第2天IAP下降到和基线比较差异有统计学意义(P<0.05)。治疗7 d后,研究组患者的有效率显著高于对照组[86.7%(13/15)比46.7%(7/15),χ^(2)=5.400,P<0.05]。结论DSA引导下经鼻肠梗阻导管置入治疗肝移植术后ACS的有效率较高,有一定的临床应用价值。Objective To study the use of digital subtraction angiography(DSA)guided transnasal ileus tube placement in management of abdominal compartment syndrome(ACS)after liver transplantation.Methods From January 2015 to December 2019,a total of 30 patients who developed ACS after liver transplantation who were admitted to the Transplantation Intensive Care Unit of Tianjin First Central Hospital were retrospectively studied.According to the way of decompression,these patients were divided into the study group and the control group.Patients in the control group were treated with conventional abdominal decompression,while patients in the study group were treated with DSA guided transnasal ileus tube placement based on management principles developed in conventional abdominal decompression.Changes in intra-abdominal pressure,treatment efficacy rates and liver functions were monitored in the two groups up to 7 days after abdominal decompression.Results There were 23 males and 7 females,aged(53.4±11.6)years.After treatment,the IAP,portal venous blood flow velocity,bile drainage volume,ALT and AST in the study group were significantly better when compared with the findings before treatment:[IAP:(7.13±3.87)vs(22.73±2.09)mmHg,portal vein blood flow velocity:(34.76±10.31)vs(21.45±6.47)cm/s,bile drainage volume:(198.43±19.94)vs(80.72±9.52)ml/d,ALT:(158.92±67.56)vs(278.73±99.17)U/L,AST:(79.36±15.63)vs(196.71±89.05)U/L],(P<0.05).After treatment,when compared with the control group,the IAP,portal vein blood flow velocity,bile drainage and TBil in the study group were significantly better[IAP:(7.13±3.87)vs(13.47±6.19)mmHg,portal vein blood flow velocity:(34.76±10.31)vs(24.98±8.54)cm/s,bile drainage:(198.43±19.94)vs(108.73±21.30)ml/d,TBil:(258.85±91.95)vs(343.69±89.45)μmol/L],(P<0.05).In the control group,the IAP significantly decreased on the fourth day after treatment,(P<0.05);compared with the significant difference in the study group on the second day after treatment(P<0.05).After 7 days of treatment,the effica

关 键 词：肝移植 腹腔间室综合征 经鼻肠梗阻导管 

分 类 号：R657.3[医药卫生—外科学]