Ozier Y, Baudin F
Département d'Anesthésie-Réanimation Chirurgicale, Groupe Hospitalier Cochin, Paris.
Ann Radiol (Paris). 1994;37(5):334-41.
Perioperative intensive care has several objectives in the context of liver transplantation. Prior to the operation, it is essential for the management of fulminant hepatic failure in order to limit the consequences of cerebral oedema. During the operation, intensive care consists of monitoring and correction of the occasionally severe circulatory and metabolic disorders induced by vascular exclusion of the liver and revascularization of the cold, ischaemic, orthotopic transplant. The possibility of major haemorrhage requiring massive transfusion with stored blood aggravates these disorders. Complex clotting disorders also play an important role; their mechanism is imperfectly understood and they are difficult to control. The severity of the problems encountered after the operation depends on graft function.
围手术期重症监护在肝移植背景下有多个目标。手术前,它对于暴发性肝衰竭的管理至关重要,以便限制脑水肿的后果。手术期间,重症监护包括监测和纠正因肝脏血管阻断以及冷缺血原位移植肝再血管化偶尔引发的严重循环和代谢紊乱。需要大量输注库存血的大出血可能性会加重这些紊乱。复杂的凝血障碍也起重要作用;其机制尚未完全明了且难以控制。术后所遇到问题的严重程度取决于移植肝功能。