老年无缺血肝移植患者的临床特点分析及对策  

Analysis of clinical features and countermeasures in elderly patients undergoing ischemia-free liver transplantation

作　　者：叶海丹[1] 于瑞[1] 罗新春[1] 张利姗 何晓顺[1] Ye Haidan;Yu Rui;Luo XinChun;Zhang Lishan;He Xiaoshun(Organ Transplant Center,The First Affiliated Hospital of Sun Yat-sen University,Guangdong Guangzhou 510080,China)

机构地区：[1]中山大学附属第一医院器官移植中心,广东广州510080

出　　处：《实用器官移植电子杂志》2024年第6期510-513,共4页Practical Journal of Organ Transplantation(Electronic Version)

基　　金：2023年度立项护理创新发展研究课题(YJYM202321)。

摘　　要：目的探讨老年无缺血肝移植患者的临床特点及护理侧重点。方法回顾性分析2017年7月至2022年12月在中山大学附属第一医院器官移植中心接受无缺血肝移植手术的107例终末期肝病患者的临床资料,其中30例年龄≥60岁的患者作为老年组,77例<60岁作为对照组,比较两组受者各器官功能恢复及术后并发症情况。结果30例老年患者术后恢复顺利,两组术后原发性移植物无功能、早期移植物功能不全、胆道并发症、急性排斥反应和肠梗阻等并发症无统计学差异。两组术后肠道排气、胃管尿管留置、重症监护病房(intensive care unit,ICU)停留及住院时间方面与对照组也无统计学差异(P>0.05)。老年组术后肺部感染发生率明显高于对照组(P<0.05)。结论老年无缺血肝移植受者与年轻受者在临床康复过程尤其是肺部感染方面有一定差异,术前进行深呼吸、有效咳嗽、呼吸功能锻炼,术后强化早期下床活动,密切进行病情观察,遵医嘱使用抗菌药物,指导正确饮食加强营养,可降低肝移植后肺部感染的发生率。Objective To investigate the clinical features of elderly patients undergoing ischemia-free liver transplantation(IFLT)and to propose nursing strategies.Methods The clinical data of 107 patients with end-stage liver disease who underwent IFLT at the Organ Transplantation Center of the First Affiliated Hospital of Sun Yatsen University from July 2017 to December 2022 were retrospectively analyzed.Thirty patients aged over 60 years old were enrolled in the elderly group and 77 patients less than 60 years old were enrolled in the control group.Results Thirty elderly patients recovered smoothly after operation.No complications such as postoperative incomplete ileus,hemorrhage and biliary complications occurred.The incidence of pulmonary infection in the elderly group was significantly higher than those in the control group(P<0.05).There was no significant difference in the postoperative hospital stay and the control group(P>0.05).Conclusion There are certain differences between elderly non ischemic liver transplant recipients and young recipients in the clinical rehabilitation process,especially in terms of pulmonary infection.Preoperative deep breathing,effective coughing,and respiratory function exercise,postoperative enhanced early mobilization,close observation of the condition,use of antibiotics according to medical advice,guidance on correct diet,and strengthening nutrition can reduce the incidence of pulmonary infection after liver transplantation.

关 键 词：肝移植 缺血/再灌注损伤 终末期肝病 老年 护理 

分 类 号：R657.3[医药卫生—外科学]