Hopfner Reinhard, Tran Thy Thai, Island Eddie R, McLaughlin Gwenn E
Department of Pediatrics, Division of Pediatric Critical Care Medicine, University of Miami, Miller School of Medicine, FL, USA.
J Intensive Care Med. 2013 Jul-Aug;28(4):215-29. doi: 10.1177/0885066611432425. Epub 2012 Jun 24.
Intestinal and multivisceral transplantation has evolved from an experimental procedure to the treatment of choice for patients with irreversible intestinal failure and serious complications related to long-term parenteral nutrition. Increased numbers of transplant recipients and improved survival rates have led to an increased prevalence of this patient population in intensive care units. Management of intestinal and multivisceral transplant recipients is uniquely challenging because of complications arising from the high incidence of transplant rejection and its treatment. Long-term comorbidities, such as diabetes, hypertension, chronic kidney failure, and neurological sequelae, also develop in this patient population as survival improves. This article is intended for intensivists who provide care to critically ill recipients of intestinal and multivisceral transplants. As perioperative care of intestinal/multivisceral transplant recipients has been described elsewhere, this review focuses on common nonsurgical complications with which one should be familiar in order to provide optimal care. The article is both a review of the current literature on multivisceral and isolated intestinal transplantation as well as a reflection of our own experience at the University of Miami.
肠道和多脏器移植已从一种实验性手术发展成为不可逆肠道衰竭及与长期肠外营养相关严重并发症患者的首选治疗方法。移植受者数量的增加和生存率的提高，导致这一患者群体在重症监护病房中的患病率上升。由于移植排斥及其治疗的高发生率所引发的并发症，肠道和多脏器移植受者的管理极具挑战性。随着生存率的提高，该患者群体还会出现糖尿病、高血压、慢性肾衰竭和神经后遗症等长期合并症。本文面向为肠道和多脏器移植重症受者提供护理的重症监护医生。由于肠道/多脏器移植受者的围手术期护理已在其他地方有所描述，本综述重点关注一些常见的非手术并发症，医生应熟悉这些并发症以便提供最佳护理。本文既是对当前多脏器和孤立肠道移植文献的综述，也是我们迈阿密大学自身经验的总结。
