Feltracco Paolo, Barbieri Stefania, Galligioni Helmut, Michieletto Elisa, Carollo Cristiana, Ori Carlo
Paolo Feltracco, Stefania Barbieri, Helmut Galligioni, Elisa Michieletto, Cristiana Carollo, Carlo Ori, Department of Pharmacology and Anesthesiology, University Hospital of Padova, Padova 35100, Italy.
World J Hepatol. 2011 Mar 27;3(3):61-71. doi: 10.4254/wjh.v3.i3.61.
Advances in pre-transplant treatment of cirrhosis-related organ dysfunction, intraoperative patient management, and improvements in the treatment of rejection and infections have made human liver transplantation an effective and valuable option for patients with end stage liver disease. However, many important factors, related both to an increasing "marginality" of the implanted graft and unexpected perioperative complications still make immediate post-operative care challenging and the early outcome unpredictable. In recent years sicker patients with multiple comorbidities and organ dysfunction have been undergoing Liver transplantation; appropriate critical care management is required to support prompt graft recovery and prevent systemic complications. Early post-operative management is highly demanding as significant changes may occur in both the allograft and the "distant" organs. A functioning transplanted liver is almost always associated with organ system recovery, resulting in a new life for the patient. However, in the unfortunate event of graft dysfunction, the unavoidable development of multi-organ failure will require an enhanced level of critical care support and a prolonged ICU stay. Strict monitoring and sustainment of cardiorespiratory function, frequent assessment of graft performance, timely recognition of unexpected complications and the institution of prophylactic measures to prevent extrahepatic organ system dysfunction are mandatory in the immediate post-operative period. A reduced rate of complications and satisfactory outcomes have been obtained from multidisciplinary, collaborative efforts, skillful vigilance, and a thorough knowledge of pathophysiologic characteristics of the transplanted liver.
肝硬化相关器官功能障碍的移植前治疗进展、术中患者管理以及排斥反应和感染治疗的改善，使人类肝移植成为终末期肝病患者有效且有价值的选择。然而，许多重要因素，既与植入移植物“边缘性”增加有关，也与围手术期意外并发症有关，这仍使术后即刻护理具有挑战性，早期预后难以预测。近年来，患有多种合并症和器官功能障碍的病情较重的患者一直在接受肝移植；需要适当的重症监护管理来支持移植物迅速恢复并预防全身并发症。术后早期管理要求很高，因为同种异体移植物和“远处”器官都可能发生重大变化。一个功能正常的移植肝脏几乎总是与器官系统恢复相关，从而为患者带来新的生活。然而，在移植物功能障碍这一不幸事件中，多器官功能衰竭的不可避免发展将需要更高水平的重症监护支持和更长时间的重症监护病房住院时间。在术后即刻，必须严格监测和维持心肺功能，频繁评估移植物功能，及时识别意外并发症并采取预防措施以防止肝外器官系统功能障碍。通过多学科协作努力、熟练的警惕性以及对移植肝脏病理生理特征的透彻了解，并发症发生率降低且取得了令人满意的结果。
