经典非转流肝移植术对肾功能损害的危险因素分析
鍏抽敭璇嶏細摘要,目的,方法,结果,结论,关键词,Riskfactorsforrenalfailureduringtheearlyperiodafterstandar
沈中阳 郑卫萍 刘懿禾
【摘要】 目的 分析经典非转流肝移植术式导致术后早期肾功能损害的相关危险因素。 方法 回顾性研究100例施行经典非转流原位肝移植病例的临床资料,根据术后是否出现急性肾功能衰竭分组,比较两组患者术前3种评分、肝和肾功能8项实验室指标以及术中10项病理、生理指标的变化,分析筛选出术后早期发生肾功能损害的危险因素。结果 单因素比较表明:两组间术前Child-Turcotte-Pugh(CTP)评分、终末期肝病模型(MELD)评分、急性生理学与慢性健康状况评分Ⅲ(APACHEⅢ)、术程、无肝期时间、出血量、最低平均动脉压、低血压持续时间等差异均具有显著性。应用Logistic回归分析筛选后保留的危险因素包括CTP评分、无肝期时间、出血量和低血压持续时间。结论 经典非转流肝移植术后早期肾功能损害的危险因素包括CTP评分、无肝期时间、出血量和低血压持续时间。
【关键词】 经典非转流肝移植术; 肾功能衰竭,急性; 评分; 危险因素
Risk factors for renal failure during the early period after standard orthotopic liver transplantation without veno venous bypass
SHEN Zhong-yang, ZHENG Wei-ping, LIU Yi-he. Department of Transplantation, Tianjin First Central Hospital, Tianjin 300192, China
OBJECTIVE: To study the risk factors for renal failure during the early period after standard orthotopic liver transplantation (SOLT) without veno venous bypass(VVBP). METHODS: Clinical data of 100 cases in whom SOLT without VVBP was performed were reviewed. They were divided into two groups according to serum creatine level just after operation. In both groups, Child-Turcotte-Pugh (CTP) score, model for end stage liver disease (MELD) score, acute physiology and chronic health evaluationⅢ(APACHEⅢ) scores, 8 laboratory variables before operation and 10 variables during the operation were analyzed, in order to screen presumable risk factors. RESULTS: With univariate analysis, it was found that there was significant difference between the two groups in the following variables: CTP score, MELD score, APACHEⅢ score, duration of operation and anhepatic phase, amount of blood loss, lowest mean artery pressure, and duration of low blood pressure. With logistic regression analysis, it was revealed that CTP score, volume of blood loss, and duration of anhepatic phase and low blood pressure were risk factors for development of acute renal failure. CONCLUSION:CTP score, volume of blood loss, duration of anhepatic phase and low blood pressure are risk factors for development of acute renal failure after SOLT without VVBP. ......
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