摘要
目的分析门脉高压脾切除术后的并发症及围手术期影响因素。方法89例门脉高压患者，男77例，女38例，年龄46．5（12～65）岁。89例行脾切除联合贲门周围血管离断术，26例行单纯脾切除。对其临床资料进行单因素分析。结果85例（73．9％）出现术后并发症，其中死亡7例（6．09％）。有并发症组入院及术前肝功能Child—Pugh A级者分别占52．9％和80．0％，均明显低于无并发症组（76．7％和96．7％，均P〈0．05）；而肝功能Child—Pugh B、C级者分别占38.8％和8．2％以及18．8％和1．2％，均明显高于无并发症组（23．3％和0，以及3．3％和0，均P〈0．05）。有并发症组术后平均血糖水平为（9．50±2．0）mmol／L，明显高于无并发症组[（8．85±2．39）mmol／L，P〈0．01]，术中平均中心静脉压（CVP）为（10．89±3．42）cmH2O，明显低于无并发症组[（12．18±2．93）cmH2O，P〈0．01]，术后平均CVP为（12．11±2．87）cm H2O，明显高于无并发症组[（11．36±2．88）cmH2O，P〈0．01]，切脾前及术后门静脉压力分别为[（36．86±7．53）cmH2O和（29．37±4．82）cmH2O，均明显高于无并发症组[（32．37±5．86）cmH2O和（25．70±5．23）cmH2O，均P〈0．01）。结论门脉高压脾切除术后并发症发生率较高。对肝功能差、手术前后门静脉压力高的患者脾切除术应慎行。控制围手术期血糖及中心静脉压，可减少并发症的发生率。
Objective To investigate the prevalence of postoperative complications after splenectomy for portal hypertension and the peri-operational influencing factors thereof. Methods 115 patients with portal hypertension, 77 males and 38 females, aged 46.5 （12-65）, underwent splenectomy combined with pericardial devascularization （n=89） or simple splenectomy （n=26）. Univariate analysis was conducted to study the relevant clinical data. Results 85 of the 115 patients （73.9%） suffered from postoperative complications, and 7 patients （6.09%） died .The proportions of patients with the liver function in Child-Pugh grades A and B at admission and before operation of the complication group were 52.9% and 80.0% respectively, both significantly lower than those of the no complication group （76.7% and 96.7% respectively, both P〈 0.05）. The proportions of liver function in the Child-Pugh grades B and C at admission and before operation of the complication group were 38.8% and 8.2%, and 18.8% and 1.2% respectively, all significantly higher than those of the no complication group （23.3% and 0, and 3.3% and 0 respectively, all P〈 0.05）. The mean post-operative blood sugar level of the complication group was （9.50± 2.0） mmol/L, significantly higher than that of the no complication group [（8.85 ±2.39）mmol/L, P〈0.01 ]. The mean intra-operative central venous pressure （CVP） of the complication group was （10.89±3.42） cmH2O, significantly lower than that of the no complication group [（12.18±2.93） cmH2O, P〈 0.01]; and the mean post-operative CVP of the complication group was （ 12.11±2.87 ） cmH2O, significantly higher than that of the no complication group [（ 11.36±2.88） cmH2O, P 〈 0.01]. The pre- and post-splenectomy portal venous pressures of the complication group were （36.86±7.53）and （29.37±4.82） cmH2O respectively, both significantly higher than those of the no complication group [（32.37±5.86）and （25.70±5.23） cmH2O respectively, both P〈 0.01]. Conclusion The complication rate is higher in the patients with portal hypertension. Operation should be performed with caution in the patients with poor liver function and portal hypertension. Control of the peri-operative blood glucose and central venous pressure help decrease the prevalence of complications.
出处
《中国急救复苏与灾害医学杂志》
2009年第7期498-500,共3页
China Journal of Emergency Resuscitation and Disaster Medicine
关键词
脾切除术
门静脉高压
并发症
围手术期
影响因素
Splenectomy
Portal hypertension
Complication, peri-operative
Factors, influencing
