肝移植术后患儿腹内高压的发生现状及危险因素分析

doi:10.3761/j.issn.0254-1769.2024.12.011

摘要/Abstract

摘要：

目的了解肝移植术后患儿腹内高压的发生现状，分析其危险因素，为临床医护人员早期识别高风险患儿，并制订肝移植术后患儿腹内高压预防和干预方案提供参考。方法该研究为前瞻性队列研究，连续选取2021年10月—2023年6月在浙江省某三级甲等医院肝移植中心接受肝移植手术的208例患儿作为调查对象，收集相关临床资料，采用经尿道膀胱测压法测量腹内压，描述其肝移植术后腹内高压的情况并进行分组，将腹内压≥10 mmHg （1 mmHg=0.133 kPa）作为腹内高压组，<10 mmHg作为非腹内高压组，采用单因素及Logistic回归分析筛选患儿发生腹内高压的危险因素。结果 208例肝移植术后患儿中，51例（24.52%）发生腹内高压，其中12例（23.53%）为Ⅰ~Ⅱ级，39例（76.47%）为Ⅲ~Ⅳ级。Logistic回归分析结果显示，移植肝重量与受体体重比（OR=1.391）、术后机械通气时间（OR=1.006）、术后中心静脉压（OR=1.375）是肝移植术后患儿发生腹内高压的影响因素（P<0.05）。结论肝移植术后患儿腹内高压发生率高，移植肝重量与受体体重比大、术后机械通气时间长、术后中心静脉压高的患儿发生腹内高压的风险较高，临床医护人员应密切关注高风险患儿，加强腹内压的动态监测并及时干预，从而减少腹内高压的发生，改善患儿预后。

关键词: 器官移植, 腹内高压, 危险因素, 儿科护理学

Abstract:

Objective To understand the status of intra-abdominal hypertension（IAH） in children after liver transplantation，and to analyze the risk factors，to provide references for clinical medical staff to identify high-risk early，and formulate the prevention and intervention program of IAH after liver transplantation. Methods A prospective cohort study was conducted，and the clinical data of 208 children who received liver transplantation from October 2021 to June 2023 in a tertiary hospital in Zhejiang Province were enrolled. The status of IAH after liver transplantation was described，and participants were divided into 2 groups according to transbladder monitoring intra-abdominal pressure levels. Children with ≥10 mmHg（1 mmHg=0.133 kPa） was classified as an intra-abdominal hypertension group，while those with <10 mmHg was classified as a non-intra-abdominal hypertension group. Results There were 51 cases （24.52%） which had IAH，including 12 cases （23.53%） of grade I to II and 39 cases （76.47%） of grade Ⅲ to Ⅳ in 208 intra-abdominal hypertension in children after liver transplantation. Binary Logistic regression analysis showed that the graft to recipient weight ratio（OR=1.391），duration of postoperative mechanical ventilation（OR=1.006），and postoperative central venous pressure（OR=1.375） were independent risk factors for IAH（P<0.05）. Conclusion The incidence of IAH in children after liver transplantation were high. Greater graft to recipient weight ratio，longer mechanical ventilation time，higher central venous pressure could increase the risk of IAH. During clinical practice，more emphasis should be strengthened on the abdominal pressure dynamic monitoring and providing timely intervention to reduce the occurrence of IAH，and improving the prognosis of children after liver transplantation.

Key words: Organ Transplantation, Intra-Abdominal Hypertension, Risk Factors, Pediatric Nursing

卢芳燕, 戴燕红, 李志茹, 吉莉, 王燕, 王华芬. 肝移植术后患儿腹内高压的发生现状及危险因素分析[J]. 中华护理杂志, 2024, 59(12): 1484-1489.

LU Fangyan, DAI Yanhong, LI Zhiru, JI Li, WANG Yan, WANG Huafen. Status and risk factors of intra-abdominal hypertension in children after liver transplantation[J]. Chinese Journal of Nursing, 2024, 59(12): 1484-1489.

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