Department of Anesthesiology, University of Nebraska Medical Center, Omaha, NE.
Department of Anesthesiology, University of Nebraska Medical Center, Omaha, NE.
J Cardiothorac Vasc Anesth. 2022 May;36(5):1449-1457. doi: 10.1053/j.jvca.2021.02.005. Epub 2021 Feb 6.
The gold standard treatment of end-stage liver disease continues to be liver transplantation (LT). The challenges of LT require skilled anesthesiologists to anticipate physiologic changes associated with end-stage liver disease and surgical considerations that affect multiple organ systems. While on the waiting list, patients may be placed on new anticoagulation medications that can confound already complex coagulopathy in LT patients. Pain management often is an afterthought for such a complex procedure, but appropriate medications can help control pain while limiting opioid medications. Surgical stress and medications for immunosuppression can affect perioperative glucose management in ways that have implications for patient and graft survival. The coronavirus disease 2019 pandemic in 2020 provided a new challenge for anesthesiologists. The uncertainty of the novel respiratory virus challenged providers beyond just LT patients.
终末期肝病的金标准治疗仍然是肝移植（LT）。LT 的挑战需要技术熟练的麻醉师预测与终末期肝病相关的生理变化以及影响多个器官系统的手术考虑因素。在等待名单上时，患者可能会被开处新的抗凝药物，这可能会使 LT 患者原本复杂的凝血功能障碍更加复杂。对于如此复杂的手术，疼痛管理通常是事后才考虑的，但适当的药物可以帮助控制疼痛，同时限制阿片类药物的使用。手术应激和免疫抑制药物的使用会影响围手术期的血糖管理，从而对患者和移植物的生存产生影响。2020 年的 2019 年冠状病毒病（COVID-19）大流行给麻醉师带来了新的挑战。这种新型呼吸道病毒的不确定性不仅对 LT 患者，也对提供者提出了挑战。
