【摘要】 [目的]探讨原位肝移植术后重症监护室监护期间脑出血的早期预防与护理。[方法]回顾性分析740例原位肝移植的临床资料，对出现脑出血病例的原因进行分析，总结术后脑出血的早期预防和护理。[结果]740例病人中，脑出血11例，发生率为1.49%(11/740)，其中7例死亡，治愈3例，1例自动出院，5例病人术后出现高血压，11例凝血障碍，6例并发感染。[结论]原位肝移植术后发生脑出血的原因是多方面的，加强对凝血功能、术中大量出血、术后高血压、感染的监控,并依此实施围术期随访等早期预防措施及护理，对提高肝移植存活率和生活质量具有重要意义。
【关键词】 肝移植;重症监护室;脑出血;预防;护理
Abstract Objective: To study the early prevention and nursing of cerebral hemorrhage patients after accepting the orthotopic liver transplantation monitored in ICU.Methods:The clinical data of 740 patients who underwent OLT in the recent years were retrospectively analyzed and to analyze reason induced cerebral hemorrhage,and the early prevention and nursing characteristics of postoperative cerebral hemorrhage in ICU were summarized.Results: In the 740 patients,11 cases (1.49%) suffered from cerebral hemorrhage,occurred within 1～49 days,7 cases died，5 dead patients had cerebral hemorrhage early,3 cases were cured,a case leaved hospital voluntarily,the intraoperative bleeding amount in 4 cases exceeded 10 000 mL,5 cases had hypertension after operation,11 cases had acoagulation disorder,6 cases complicated with infected.Conclusion:The reasons of cerebral hemorrhage after OLT were various.To strengthen monitoring blood coagulation function,intraoperative hemorrhoea,postoperative hypertension and infection,and to carry out followup for them in perioperative period will be activelyfor advancing the livability and life quality of patients after OLT.
Key words liver transplantation;intensive care unit;cerebral hemorrhage;prevention;nursing
肝移植是治疗终末期肝病的有效手段，由于手术复杂、术后并发症多，治疗期间发生脑出血预后差、病死率高，是导致肝移植术失败的主要原因之一。我院完成的740例原位肝移植术中，11例出现脑出血症状。对11例病人出现脑出血的原因进行分析，总结术后脑出血早期预防和护理要点。
1 临床资料
1.1 一般资料 11例原位肝移植病人在术后重症监护室(ICU)监护期间发生脑出血，其中男9例，女2例;年龄35岁～66岁，平均45.4岁;原发病8例为慢性重型肝炎，2例为原发性肝癌，1例为多囊肝。肝移植手术方式为经典原位肝移植术，术后予他克莫司(FK506)、骁悉、激素三联基础免疫抑制抗排斥治疗，维持治疗采用以FK506为主要药物的个体化免疫抑制方案。
1.2 脑出血的治疗与转归 对于可疑脑出血病人进行头颅CT检查，11例病人脑出血发生时间为1 d～49 d
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