【摘要】 目的 探讨原位肝移植术后血乳酸和肝功能的动态变化的临床意义。方法 64例原位肝移植患者术毕即转入重症监护病房(ICU)，对全身重要脏器的功能和症状体征进行监测的同时观察血乳酸及肝功能动态变化值并分析相关因素。结果 原位肝移植术后患者血乳酸值正常或迅速下降至正常，患者肝功能恢复迅速预后良好，二者成正相关(P<0.01)。乳酸持续超过正常肝功能损害重预后不良。结论 动态血乳酸值是判断原位肝移植术后预后的良好指标。
【关键词】 肝移植; 重症监护; 血乳酸; 肝功能
The Monitoring and Signioficance of Blood Lactate Lever and Liver Function after Orthotopic Liver Transplantation During ICU of 64 Cases
Xia Hongjie,Wang Jie, Liu Yahua,Gao Hongsheng,Wang Qian,Zhang Yanjun
(Emergency Department,General Hospital of Chinese Peoples Armed Police s Forces,Beijing 100039,China)
Abstract： Objective To study the clinical significance of blood lactate level and liver function after orthotopic liver transplantation (OLT) operation.Methods Between May 2002 and Feb 2003, 64 consecutive patients underwent OLT.After operation, the patients were send to intersive care unit (ICU) of hospitalThe physiological function were determined,the symptopms and signs were observd, the blood lactate levere and liver function were measured befire,durung and after operation 1,12,36,60 hours,observed changes and amalysed relativity factors.Results In the 64 patients,the liver function came back favorable which the blood lactate levers were decreased rapidly to normal.They had positive correlation(P<0.01),contrarily,the liver function came back slowly or liver failure which the blood lactate levers were higher then normal.Conclusion To evaluate and montitring the blood lactate levels are excellent indicators of estimate OLT prognosis.
Key words： liver transplantation;intersive care unit;blood lactate;liver function
肝脏移植是治疗中晚期肝病最有效的措施。肝移植手术和麻醉技术的提高及围手术期监护经验的不断丰富大大提高了肝移植患者的生存率。我们对64例肝移植患者术后早期ICU监护期间的血乳酸水平及肝功能进行观察，并试评价乳酸与其他肝功能指标的关系。
1 资料与方法
11 对象 2002年5月—2003年2月在我院共进行同种异体原位肝移植64例，所有患者术后均转入ICU进行监护，其中男性62例，女性2例，年龄31~70岁，平均46岁。原发病为：慢性肝炎后肝硬化34例，原发性肝癌26例，乙醇性肝硬化2例，重症肝炎肝性脑病2例。其中4例于移植后1个月内死于肝功能衰竭，3例于术后1~3个月内死于颅内真菌感染，其他病例随访均生存超过半年。
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