Kramer David J, Siegal Eric M, Frogge Sarah J, Chadha Manpreet S
Aurora Critical Care Service, Advocate Aurora Health Care, 2901 W Kinnickinnic River Parkway, Suite 305, Milwaukee, WI 53215, USA; Department of Medicine, University of Wisconsin School of Medicine and Public Health in Madison, 750 Highland Avenue, Madison, WI 53726, USA.
Aurora Critical Care Service, Advocate Aurora Health Care, 2901 W Kinnickinnic River Parkway, Suite 305, Milwaukee, WI 53215, USA; Department of Medicine, University of Wisconsin School of Medicine and Public Health in Madison, 750 Highland Avenue, Madison, WI 53726, USA.
Crit Care Clin. 2019 Jan;35(1):95-105. doi: 10.1016/j.ccc.2018.08.012.
Perioperative management of the liver transplant recipient is a team effort that requires close collaboration between intensivist, surgeon, anesthesiologist, hepatologist, nephrologist, other specialists, and hospital staff before and after surgery. Transplant viability must be reassessed regularly and particularly with each donor organ. Regular discussions with patient and family facilitate realistic determinations of goals based on patient aspirations and clinical realities. Early attention to hemodynamics with optimal resuscitation and judicious vasopressor support, respiratory care designed to minimize iatrogenic injury, and early renal support is key. Preoperative and postoperative nutritional support and physical rehabilitation should remain a focus.
肝移植受者的围手术期管理需要团队协作，在手术前后，重症监护医生、外科医生、麻醉医生、肝病专家、肾病专家、其他专科医生以及医院工作人员之间必须密切合作。必须定期重新评估移植的可行性，尤其是对于每个供体器官。与患者及其家属进行定期讨论，有助于根据患者的期望和临床实际情况切实确定目标。早期关注血流动力学，进行最佳复苏和明智的血管升压药支持，采取旨在尽量减少医源性损伤的呼吸护理，以及早期肾脏支持是关键。术前和术后的营养支持及身体康复应始终是重点。
