Allison M E, Prentice C R, Kennedy A C, Blumgart L H
Br J Surg. 1979 Jun;66(6):392-7. doi: 10.1002/bjs.1800660606.
Renal function and other factors that possibly affect the outcome of operation were measured in 24 patients with obstructive jaundice and in 15 non-jaundiced controls. The preoperative features that were associated with a poor postoperative recovery from obstructive jaundice were a raised serum fibrinogen/fibrin degradation product concentration, infection, hypoalbuminaemia and a low glomerular filtration rate. Preoperative serum fibrinogen/fibrin degradation product concentrations were raised in 4 of the 6 jaundiced patients who died after surgery but in none of the controls, in whom there was no mortality. In the jaundiced patients there was a greater incidence of postoperative renal impairment than in the controls. All patients were given mannitol during operation. Further mannitol was required after surgery in 13 of the 24 jaundiced patients in order to maintain urine flow rate despite adequate intravenous fluids being given. In contrast, only 1 of the 15 control patients required post operative mannitol. It is emphasized that repeated doses of mannitol can lead to a profound natriuresis and adequate intravenous saline should be given.
对24例梗阻性黄疸患者和15例非黄疸对照者测定了肾功能及其他可能影响手术结果的因素。与梗阻性黄疸术后恢复不佳相关的术前特征包括血清纤维蛋白原/纤维蛋白降解产物浓度升高、感染、低白蛋白血症和肾小球滤过率降低。6例术后死亡的黄疸患者中有4例术前血清纤维蛋白原/纤维蛋白降解产物浓度升高，而15例无死亡的对照者中无一例升高。黄疸患者术后肾功能损害的发生率高于对照者。所有患者在手术期间均给予甘露醇。24例黄疸患者中有13例术后需要进一步给予甘露醇以维持尿流率，尽管已给予足够的静脉补液。相比之下，15例对照患者中只有1例术后需要甘露醇。强调重复给予甘露醇可导致严重的利钠作用，应给予足够的静脉生理盐水。
