肝移植术患者术后早期并发急性肾功能衰竭的危险因素

目的 分析肝移植术患者术后早期并发急性肾功能衰竭(ARF)的危险因素.方法 择期行肝移植术的终末期肝病患者60例,年龄28～64岁,术前血清肌酐和尿素未见异常.根据术后24h内是否发生ARF,分为2组:ABF组与非ARF组(NARF组).可能的危险因素进行组间比较后,将差异有统计学意义的因素进行logistic回归分析,筛选发生ARF的危险因素.结果 logistic回归分析结果显示,术前血β1-微球蛋白高于正常值、术中持续性低血压与术后早期并发ABF有关(P＜0.05).结论 肝移植术患者术前血β2-微球蛋白高于正常值和术中发生持续性低血压是术后早期并发ABF的危险因素.

Risk factors for development of early acute renal failure after liver transplantation in patients with normal renal function

Objective To determine the risk factors for development of early acute renal failure (ARF) after orthotopic liver transplantation (OLT) in patients with normal renal function.Methods Sixty ASA Ⅱ or Ⅲ patients aged 28-64 yr weighing 35-88 kg undergoing OLT were studied.Their preoperative serum Cr and BUN were within normal range.Early ARF was defined as serum Cr≥132 μmol/L and/or BUN≥18 mmol/L within 24 h after operation.The patients were divided into 2 groups: ARF group and non-ARF group.Arterial blood samples and urine specimens were collected before induction of anesthesia for determination of blood β2-micreglobulin(β2-MG) and urinary β2-MG and N-acetyl-β-D-glucurenidnse (NAG). Factors including preoperative liver function,preoperative blood and urinary β2-MG,the amount of urine output and bank blood infused during operation,MAP during anhepatic and neohepatic phase,the amount of vnsoactive drugs and diuretics used during operation,hypotension and arrbythmia during operation were recorded.The risk factors were identified by logistic regression analysis.Results Logistic analysis indicated that serum β2-MG higher than normal value before operation and persistent hypotensien during operation were closely correlated with development of early ARF after OLT.Conclusion Serum β2-MG higher than the normal value before operation.and persistent hypotension during operation are the risk factors for early ARF after OLT.