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Kidney Transplant II: Surgical Procedure01:26

Kidney Transplant II: Surgical Procedure

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Preoperative ManagementThe primary goals of preoperative management in kidney transplantation are to optimize the patient’s metabolic state and prepare them for surgery through diet adjustments, necessary dialysis, and tailored medical treatment. This phase also involves comprehensive infection screening and patient education about the surgical procedure and postoperative care to improve outcomes and adherence.Medical ManagementA comprehensive evaluation is required for both the living...
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During the postoperative period, it is crucial to focus on maintaining circulation, identifying and managing potential complications, and planning for discharge.Nursing AssessmentVital signs monitoring: Regularly monitor vital signs, including blood pressure, heart rate, respiratory rate, and temperature, to detect early signs of complications such as bleeding and infection.Circulation assessment: Monitor pulses, perform Doppler assessments, and check capillary refill, color, temperature, and...
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Cardiomyopathy VII: Pre and Post Operative Nursing Management01:28

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Patients with hypertrophic cardiomyopathy (HCM) and left ventricular outflow tract (LVOT) obstruction who remain symptomatic despite optimal medical therapy may undergo a septal myectomy (Morrow procedure). This procedure involves excising a portion of the hypertrophied septum below the aortic valve using a heart-lung machine to improve blood flow through the LVOT. Effective preoperative and postoperative nursing management ensures successful patient outcomes, minimizes complications, and...
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Aneurysm III: Interprofessional Care01:26

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Aneurysm management involves either conservative medical therapy or surgical intervention, depending on the size and symptoms of the aneurysm. Conservative management is generally reserved for smaller, asymptomatic aneurysms, while larger or symptomatic aneurysms often necessitate surgical repair.Conservative Medical TherapyFor small, asymptomatic aneurysms, particularly abdominal aortic aneurysms (AAA) less than 5.5 centimeters in diameter, conservative medical therapy is recommended. This...
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Vigilant monitoring for aneurysm rupture is essential for patients undergoing aortic surgery.Preoperative Nursing ManagementContinuously monitor the patient for manifestations of aneurysm rupture, such as pallor, weakness, tachycardia, hypotension, abdominal, back, groin, or periumbilical pain, changes in consciousness, and a pulsating abdominal mass. Regularly assess the patient's peripheral pulses.Instruct the patient to consume a clear liquid diet the day before surgery and administer...
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Esophageal varices often manifest as gastrointestinal bleeding episodes, presenting symptoms like hematemesis (vomiting of blood), hematochezia (passing fresh blood via the rectum), and melena (black, tarry stools). Other signs can include weight loss, anorexia, abdominal discomfort, jaundice, pruritus, altered mental status, and muscle cramps.
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関連する実験動画

Updated: Jan 15, 2026

Application of Hemostatic Devices in Laparoscopic Hepatectomy
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心移植後の重度の術後出血

Alexandre Mansour1, Adrien Bougle2, Marion Turpin3

  • 1Department of Anesthesia and Critical Care, Pontchaillou, University Hospital of Rennes, Univ Rennes, CHU Rennes, CIC 1414 (Centre d'Investigation Clinique de Rennes), Inserm, IRSET, UMR_S 1085, FHU SUPORT, F35000 Rennes, France. ORCID0000-0001-8955-2407.

Anesthesiology
|January 13, 2026
PubMed
まとめ

重度の出血合併症は心移植レシピエントの25％に発生し、1年死亡率を増加させる。機械的心サポートおよび心肺バイパス時間は、移植後出血の主要な危険因子である。

キーワード:
心移植術後出血出血合併症危険因子死亡率

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科学分野:

  • 循環器病学
  • 移植外科
  • 集中治療医学

背景:

  • 術後出血は心臓手術において一般的な懸念事項です。
  • しかし、心移植後の発生率、危険因子、および結果は十分に定義されていません。
  • 重度の出血合併症は患者の転帰に著しく影響します。

研究 の 目的:

  • 成人心移植レシピエントにおける重度の出血合併症の発生率を決定すること。
  • 重度の術後出血に関連する危険因子を特定すること。
  • 重度の出血が1年死亡率に及ぼす影響を評価すること。

主な方法:

  • 2つのフランスのセンターで2015年から2022年までの成人心移植患者を対象とした観察研究が実施されました。
  • 重度の出血は、Universal Definition of Perioperative Bleeding（UDPB）スコア≥3を使用して定義されました。
  • 多変量ロジスティック回帰モデルおよびCox回帰モデルを使用して、危険因子を特定し、死亡率への影響を評価しました。

主要な成果:

  • 446人の患者のうち112人（25％）が重度の出血を経験しました。
  • 危険因子には、長期の機械的心サポート、術前のヘモグロビン値の低さ、および心肺バイパス（CPB）時間の長さが含まれていました。
  • 重度の出血は、1年死亡率の増加（35％対13％、調整後ハザード比1.91）と関連していました。

結論:

  • 心移植後の重度の出血性合併症の発生率は高く、特に機械的循環サポートを受けている患者で顕著です。
  • これらの出血イベントは、患者の罹患率と死亡率を著しく増加させます。
  • 心移植後の出血に対する効果的な予防戦略を開発するためには、さらなる研究が必要です。