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[麻醉医生在肝移植中的作用——术前评估]

[The Role of the Anaesthesiologist in Liver Transplantation - Preoperative Evaluation].

作者信息

Müller Markus, Grasshoff Christian

出版信息

Anasthesiol Intensivmed Notfallmed Schmerzther. 2024 May;59(5):283-295. doi: 10.1055/a-2152-7350. Epub 2024 May 17.

Abstract

Preoperative evaluation prior to listing for orthotopic liver transplantation (LT) requires a careful multidisciplinary approach with specialized teams including surgeons, hepatologists and anesthesiologists in order to improve short- and long-term clinical outcomes. Due to inadequate supply of donor organs and changing demographics, patients listed for LT have become older, sicker and share more comorbidities. As cardiovascular events are the leading cause for early mortality precise evaluation of risk factors is mandatory. This review focuses on the detection and management of coronary artery disease, cirrhotic cardiomyopathy, portopulmonary hypertension and hepatopulmonary syndrome in patients awaiting LT. Further insights are being given into scoring systems, patients with Acute-on-chronic-liver-failure (ACLF), frailty, NASH cirrhosis and into psychologic evaluation of patients with substance abuse.

摘要

在列入原位肝移植(LT)名单之前进行术前评估,需要由外科医生、肝病专家和麻醉师等专业团队采取谨慎的多学科方法,以改善短期和长期临床结果。由于供体器官供应不足和人口结构变化,列入LT名单的患者年龄更大、病情更重且合并症更多。由于心血管事件是早期死亡的主要原因,因此必须精确评估风险因素。本综述重点关注等待LT的患者中冠状动脉疾病、肝硬化性心肌病、门肺高压和肝肺综合征的检测与管理。还进一步探讨了评分系统、慢性肝衰竭急性加重(ACLF)患者、虚弱、非酒精性脂肪性肝炎肝硬化以及药物滥用患者的心理评估。

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