Objective To explore the risk factors for the returning of pediatric liver transplant recipients to the intensive care unit (ICU) and provide reference for the clinical decision-making after surgery. Methods A retrospective analysis was conducted with the information of all the pediatric patients who underwent liver transplantation in Ren Ji Hospital,Shanghai Jiao Tong University School of Medicine and were returned to the ICU from 2019 to 2021.The patients returned to the ICU during hospitalization and the reasons for the return were recorded.Each patient of ICU return was matched with three pediatric patients who did not return to the ICU during hospitalization.The basic information,the vital signs and laboratory indicators on the day of transfer from ICU,immunosuppressants and drug concentrations were compared between the two groups.Multivariate Logistic regression analysis was performed to explore the risk factors for the returning of pediatric liver transplant recipients to the ICU. Results The returning rate of pediatric liver transplant recipients to the ICU was 4.36%,and it was 16.00% within 48 h.The main reasons for the return included respiratory complications,abdominal infections,and hepatic vascular occlusion.Multivariate Logistic regression analysis showed that post-operative red blood cell transfusion (OR=4.554,95%CI=1.743-11.901,P=0.002) and high serum level of uric acid (OR=1.005,95%CI=1.001-1.009,P=0.014) were the risk factors for returning to the ICU.High diastolic blood pressure (OR=0.922,95%CI=0.885-0.960,P<0.001) and high total protein level (OR=0.937,95%CI=0.891-0.986,P=0.012) were the protective factors for returning to the ICU. Conclusion Post-operative red blood cell transfusion and high serum level of uric acid are independent risk factors for the returning of pediatric liver transplant recipients to the ICU.

随着外科技术不断的发展和改进,儿童肝移植现已经成为儿童终末期肝病、肝功能衰竭、遗传代谢性肝病及常规治疗手段无效的肝脏恶性肿瘤的最佳治疗手段[1-3].但移植术后排斥反应及感染等并发症的预防和治疗仍是不可忽视的一大重点.国内学者研究显示儿童活体肝移植术后3个月发生细菌和(或)真菌感染率为36.4％[4],临床上由感染引起的脓毒血症致多器官功能障碍极为常见,其中急性肾损伤(acute kidney injury,AKI)是脓毒症最常见的并发症之一,30％ ～ 40％的重症监护病房(intensive care unit,ICU)患者受到严重威胁[5].儿童AKI的起病原因复杂多样,其中脓毒症相关急性肾损伤病程进展更快,死亡风险更高.肾脏替代疗法是治疗AKI有效的方法,主要包括体外血液净化以及腹膜透析.上海交通大学医学院附属仁济医院肝脏外科于2021年8月收治了1例婴儿肝移植术后脓毒血症休克、心功能不全伴肾功能不全,经肾内科联合会诊、邀请腹膜透析专科护士协助重症护理,积极抗感染并行床边腹膜透析治疗9 d后取得良好效果,现将护理体会报道如下.

肝肺综合征(hepatopulmonary syndrome,HPS)是慢性肝病的严重并发症之一[1],指无心肺基础疾病的肝功能不全患者肺内血管扩张与新生,至气体交换功能障碍而出现严重低氧血症[2-4].

报告1例胆道闭锁婴儿肝移植术后失禁性皮炎(IAD)的护理经验.该婴儿因术后腹泻致臀和会阴大面积重度IAD,经纠正腹泻、结构化的皮肤管理、家属教育和共同参与等个性化治疗和护理,婴儿的IAD得以快速康复.