主要的肝切除,外科手术期间的问题和肝切除术后的肝衰竭:麻醉师的全面更新
Andrea De Gasperi1, Laura Petrò2, Ombretta Amici3
1Former Head, Anesthesia and Critical Care Service 2, Grande Ospedale Metropolitano Niguarda ASST GOM Niguarda, Milan 20163, Italy. dottdega@gmail.com.
World journal of critical care medicine
|June 10, 2024
概括
麻醉科医生在管理大肝切除方面发挥着至关重要的作用,通过解决术后问题来预防肝切除术后肝衰竭 (PHLF). 积极的策略和重症监护对于改善这些复杂手术的结果至关重要.
科学领域:
- 肝胆道手术 肝胆道手术
- 麻醉学 麻醉学
- 关键护理医学 关键护理医学
背景情况:
- 由于外科手术的进步,主要的肝脏切除已经扩大,需要改善外科手术期间的管理.
- 肝切除术后肝衰竭 (PHLF) 是一种严重的并发症,导致大量的术后死亡率.
- 最佳的术后护理和密集监测对于成功的肝脏手术结果至关重要.
研究的目的:
- 审查主要肝切除术中麻醉师的关键外科问题.
- 突出预防和管理肝切除术后肝衰竭 (PHLF) 的策略.
- 强调外科医生,麻醉科医生和重症治疗师的合作作用.
主要方法:
- 关于主要肝切除和术后管理的当前文献的综述.
- 对影响PHLF的手术操作的系统后果的分析.
- 讨论PHLF的密集治疗选择,包括人工肝脏支持.
主要成果:
- 麻醉师必须掌握手术前评估,手术内策略和手术后增强恢复 (ERAS) 协议.
- PHLF,分级A-C,发生在9%-30%的病例中,是90天死亡的主要原因.
- 积极管理可以预测,预防或预测PHLF,而密集治疗的目的是支持本地肝脏的恢复或促进移植.
结论:
- 积极的麻醉方法对于减轻PHLF风险至关重要.
- 密集护理和先进的治疗对于管理严重的PHLF至关重要.
- 手术,麻醉学和重症监护团队之间的多学科合作对于最佳的患者结果是强制性的.
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