| 摘要: |
| 目的:从肝移植患者术前、术中和术后早期的各项指标中筛选肝移植术后早期（术后至出院）死亡的高危因素，为提高肝移植术后生存率奠定基础。方法：回顾性分析长征医院2001年5月至2005年9月间307例肝移植患者围手术期临床资料，单因素分析术后早期死亡的可能危险因素，对有价值的指标进行多因素Logistic回归分析，筛选确切的高危因素。结果：4例患者因资料不全剔除，303例参与此次回顾性分析。单因素分析结果提示性别、Child分级、肝性脑病、肝肾综合征、早期拔管时间、白细胞计数、术前血红蛋白（Hb）、血尿素氮、血肌酐、凝血酶原时间、血钠、血钾、腹水量、手术时间、术中尿量、大量输血、术中输碳酸氢钠量、吸空气时动脉氧分压（PaO2）、胆红素、术前终末期肝病模型（MELD）评分等20项因子是术后早期死亡危险因素。多因素Logistic回归分析结果显示，女性、低血钠、手术时间长、大量输血（>7 500 ml）、术前高MELD分值等5项因子是肝移植术后早期死亡的独立危险因素。结论：女性、低血钠、手术时间长、大量输血者、术前高MELD评分的患者肝移植术后早期病死率较高，临床应根据患者具体情况采取针对性的措施。 |
| 关键词: 肝移植 早期病死率 危险因素 |
| DOI：10.3724/SP.J.1008.2008.01421 |
| 投稿时间：2008-04-14修订日期：2008-06-25 |
| 基金项目:上海市卫生局科研基金(2006076). |
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| Risk factors for early mortality after liver transplantation: a retrospective analysis |
| SHI Xue-yin1*,MA Li2,XU Hai-tao1,HE Xing-ying1,ZOU Zui1,YUANG Hong-bin1,FU Hong3,FU Zhi-ren3 |
| (1.Department of Anesthesiology,Changzheng Hospital,Second Military Medical University,Shanghai 200003,China*2.Department of Anesthesiology,General Hospital,PLA Beijing Military Area Command,Beijing 100700*3.Departement of Organ Transplantation,Changzheng Hospital,Second Military Medical University,Shanghai 200003) |
| Abstract: |
| Objective:To screen for the perioperative risk factors contributing to early mortality in liver transplant recipients,so as to lay a foundation for improving the survival rate after transplantation.Methods: The clinical data of 307 patients,who received liver transplantation (LT) between May 2001 and Sep.2005 in Changzheng Hospital,were retrospectively investigated.Risk factors that might contribute to early postoperative mortality(early mortality was defined as death before the first permission of discharge from hospital) were subjected to univariate analyses.Factors of significance were analyzed by means of Logistic regression to screen for high risk factors.Results: The clinical data of 4 patients were excluded due to incompleteness and the remaining 303 patients were included in the present study.Results of univariate analyses showed that 20 factors were related to early mortality after LT,including the gender,Child-pugh classification,hepatic encephalopathy,hepatorenal syndrome,time of extubation,leukocyte count,preoperative hematoglobin concentration,blood urea nitrogen,creatinine,prothrombin time(PT),serum sodium and potassium level,volume of ascites,duration of operation,urine volume during operation,massive blood transfusion,volume of sodium bicarbonate during operation,PaO2 when breathing air,bilirubin,and model for end-stage liver disease (MELD) score.Results of multifactor Logistic regression analysis showed that 5 factors were independent risk factors of early mortality after LT,including female gender,low serum sodium level,long operative time,large volume of blood transfusion (>7 500 ml),and high MELD score.Conclusion:It is indicated that female gender,low serum sodium level,long operative time,large volume of blood transfusion and high MELD score are risk factors for early motality after LT. |
| Key words: liver transplantation early mortality risk factor |
