基于常温机械灌注不中断血流保存供肝肝移植的手术配合
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摘要
目的总结基于常温机械灌注不中断血流保存供肝的肝移植手术配合要点。方法 10例患者在常温机械灌注保存供肝下进行肝移植手术,做好供肝获取和保护,不间断加强血流供肝获取的手术配合,准备灌注液、灌注机器,做好常温机械灌注供肝期的安全管理,手术期体温的控制以及供肝植入手术的护理。结果 10例手术均顺利完成,术后恢复良好,出院前肝功能各项指标均恢复正常水平,未发生手术并发症,术后每个月随访复查肝功能,10例患者均未发生急性排斥反应,有1例患者术后1个月复查丙氨酸氨基转移酶(ALT)偏高,予护肝等综合治疗后恢复正常。结论常温机械灌注保存供肝在肝移植手术应用效果显著,充分的术前准备,医护人员扎实的专业技术及密切的合作,是提高手术效率及保证手术顺利进行的关键。
Objective To summarize of the key points of intraoperative nursing cooperation for liver transplantation using donated liver grafts preserved through sanguineous normothermic machine perfusion.Methods A total of 10 patients received liver transplantation using donated liver grafts preserved through sanguineous normothermic machine perfusion.During the donor operation,nurses assisted the harvest and preservation of donated liver grafts,paid special care to liver harvest without interruption of blood flow,prepared filling liquid and filling machine,and ensured safety of sanguineous normothermic machine perfusion;during transplantation,nurses made the recipients′body temperature under control,and provided professional care for liver implantation.Results The 10 surgeries went on smoothly,and the recipients achieved good recovery after operation.Their liver profile returned to normal at discharge and no one developed surgery-related complications.The 10 cases were asked to check liver profile monthly after discharge,and no one developed acute rejection.Only one patient had a slight increase in alanine transaminase(ALT)values at1 month after operation,and the index later returned to normal after liver protecting therapies.Conclusion Liver transplantation using donated liver grafts preserved through sanguineous normothermic machine perfusion can yield excellent effect.To improve surgical efficiency and smooth the surgery,medical staff need to make full preparation before the surgery,improve professional skill levels and work in close cooperation.
Objective To summarize of the key points of intraoperative nursing cooperation for liver transplantation using donated liver grafts preserved through sanguineous normothermic machine perfusion.Methods A total of 10 patients received liver transplantation using donated liver grafts preserved through sanguineous normothermic machine perfusion.During the donor operation,nurses assisted the harvest and preservation of donated liver grafts,paid special care to liver harvest without interruption of blood flow,prepared filling liquid and filling machine,and ensured safety of sanguineous normothermic machine perfusion;during transplantation,nurses made the recipients′body temperature under control,and provided professional care for liver implantation.Results The 10 surgeries went on smoothly,and the recipients achieved good recovery after operation.Their liver profile returned to normal at discharge and no one developed surgery-related complications.The 10 cases were asked to check liver profile monthly after discharge,and no one developed acute rejection.Only one patient had a slight increase in alanine transaminase(ALT)values at1 month after operation,and the index later returned to normal after liver protecting therapies.Conclusion Liver transplantation using donated liver grafts preserved through sanguineous normothermic machine perfusion can yield excellent effect.To improve surgical efficiency and smooth the surgery,medical staff need to make full preparation before the surgery,improve professional skill levels and work in close cooperation.
引文
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[9]Karangwa S A,Burlage L C,Adelmeijer J,et al.Activation of fibrinolysis,but not coagulation,during end-ischemic ex situ normothermic machine perfusion of human donor livers[J].Transplantation,2017,101(2):e42-e48.
[10]廖丹,吴敏,潘映云,等.肝胰十二指肠器官簇移植术的手术配合[J].中华护理杂志,2011,46(8):779-780.
[11]石英,何洹,易建华,等.心脏死亡器官捐献中应用体外膜肺氧合的配合与监护[J].护理学杂志,2013,28(8):51-53.
[12]高兴莲,黄靖,许娜,等.心肝联合移植手术的护理配合[J].中华护理杂志,2013,48(3):219-221.
[13]余文静,高兴莲,吴佳颖.23例心脏移植手术患儿的护理[J].中华护理杂志,2017,52(4):414-417.
[2]Han M,Guo Z Y,Zhao Q,et al.Liver transplantation using organs from deceased organ donors:a single organ transplant center experience[J].Hepatobiliary Pancreat Dis Int,2014,13(4):409-415.
[3]Liu Q,Nassar A,Farias K,et al.Comparing Normothermic Machine Perfusion Preservation With Different Perfusates on Porcine Livers From Donors After Circulatory Death[J].Am J Transplant,2016,16(3):794-807.
[4]Op D D S,Karimian N,Sutton M E,et al.Ex vivo normothermic machine perfusion and viability testing of discarded human donor livers[J].Am J Transplant,2013,13(5):1327-1335.
[5]郭志勇,吉斐,张志衡,等.常温机械灌注改善临床心脏死亡供肝功能的可行性及机制[J].中华重症医学电子杂志(网络版),2017,3(2):100-106.
[6]Nassar A,Liu Q,Farias K,et al.Ex vivo normothermic machine perfusion is safe,simple,and reliable:results from a large animal model[J].Surg Innov,2015,22(1):61-69.
[7]Nassar A,Liu Q,Farias K,et al.Impact of temperature on porcine liver machine perfusion from donors after cardiac death[J].Artif Organs,2016,40(10):999-1008.
[8]Liu Q,Nassar A,Farias K,et al.Sanguineous normothermic machine perfusion improves hemodynamics and biliary epithelial regeneration in donation after cardiac death porcine livers[J].Liver Transpl,2014,20(8):987-999.
[9]Karangwa S A,Burlage L C,Adelmeijer J,et al.Activation of fibrinolysis,but not coagulation,during end-ischemic ex situ normothermic machine perfusion of human donor livers[J].Transplantation,2017,101(2):e42-e48.
[10]廖丹,吴敏,潘映云,等.肝胰十二指肠器官簇移植术的手术配合[J].中华护理杂志,2011,46(8):779-780.
[11]石英,何洹,易建华,等.心脏死亡器官捐献中应用体外膜肺氧合的配合与监护[J].护理学杂志,2013,28(8):51-53.
[12]高兴莲,黄靖,许娜,等.心肝联合移植手术的护理配合[J].中华护理杂志,2013,48(3):219-221.
[13]余文静,高兴莲,吴佳颖.23例心脏移植手术患儿的护理[J].中华护理杂志,2017,52(4):414-417.