原位肝移植合并重症脓毒症病人的临床研究

目的观察肝移植合并重症脓毒症病人的相关检验和临床指标,旨在总结原位肝移植合并重度脓毒症这一特殊感染人群的ICU治疗经验。方法回顾性分析入住外科ICU术后的56例符合重症脓毒症标准者病人,分成2组：非肝移植组（A组）和肝移植组（B组）。分别在第1天、第3天和第7天记录病人一般情况、血乳酸、器官衰竭个数、APACHEⅡ评分和MODS评分。观察住院28d的存活率和随访情况。结果非肝移植组合并重症脓毒症住院死亡率30％,而在肝移植组则为57．6％。肝移植组第l天血乳酸比非肝移植组明显升高,差异有统计学意义（P〈0．01）,随之有所下降,但7d内仍然高于非肝移植组;肝移植组器官衰竭个数比非肝移植组明显增多,差异有统计学意义（P〈0．01）;2组观察期间APACHEⅡ动态评分差异无统计学意义（P〉0．05）;MODS动态评分在肝移植组比非肝移植组明显升高,差异有统计学意义（P〈0．01）。结论原位肝移植合并重症脓毒症住院28d死亡率约是非肝移植组的2倍,值得高度重视。原位肝移植合并重症脓毒症病人更容易合并有多器官功能衰竭且病情较难逆转。肝移植合并重症脓毒症病人判断病情和器官功衰竭程度的轻重,MODS评分优于APACHEⅡ评分。建议改进或者制定器官移植特有的评分标准并且应该加入血乳酸。

The clinical study of orthotopic liver transplantation patients with severe sepsis

Objective To improve the treat effect of the orthotopic liver transplantation patients with severe sepsis. Methods Fif-ty-six post-surgery patients were enrolled in this study. Patients were divided into two groups. One was non-OLT group (A group) and the other was OLT group (B group). Besides general data, the surveillance of blood lactate, the number of failure organs, APACHE Ⅱand MODS were recorded. 28-days survival rate and follow-up were checked. Results The mortality of hospitalization in non-OLT group was 30% and 57.6% in OLT group. The level of blood lactate in OLT group at the 1 st day increased significantly, which was statistically differ-ent with that in non-OLT group (P <0.01). It decreased but kept higher than that in non-group in following seven days. The numbers of failure organs in OLT group were more than in non-OLT group (P <0.01). The continuous APACHE Ⅱ score had no significant difference between two groups. But the continuous MODS score in OLT group was higher than in non-OLT group (P <0.01). Conclusions The 28-days mortality of OLT with severe sepsis is almost two times as much as that of non-OLT. It should cause more attention. The OLT with se-vere sepsis is more likely suffered from failure organs and difficult to recovery. To assess the condition of failure organs in OLT patients with severe sepsis, MODS score is better than APACHE Ⅱ score in this study. It is suggested that the standard of score system could be improved or come up with new score for organ transplantation. It will be better if blood lactate score is included.