肝移植术后早期急性肾功能衰竭的预防和治疗

目的 探讨原位肝移植术后早期急性肾功能衰竭的预防和治疗措施.方法 对2004年1月至2006年12月中山大学附属第一医院施行的516例同种原位肝移植患者的临床资料进行回顾件分析.总结肝移植术后早期急性肾功能衰竭(ARF)的发生情况.结果 共发生早期急性肾功能衰竭106例(20.5%),其中属轻度21例,中度40例,重度45例.分别采取了纠正肾前性因素、调整免疫抑制方案、药物疗法和血液净化相结合的综合防治措施,其中有21例重度肾功能不全者术后需行连续肾脏替代治疗(CRRT).在本组资料中,原发病为重型肝炎患者75例,术后36例合并ARF,发生率明显高于其他原发病(P<0.05);4例术前存在重度肾功能不全者,术后有3例发生ARF,明显高于其他术前轻-中度肾功能不全者的术后ARF的发生率(P<0.05).106例肝移植术后早期ARF患者,术后1个月内死亡37例,病死率为34.9%,且终末期肝病模型(MELD)评分值≤20分组的1个月存活率显著高于MELD值为20～30分组和>30分两组.结论 肝移植术后ARF的防治是一个从术前评估到术后管理的系列过程;术前完善对患者的评估,术中采取多方面措施保护肾脏功能,术后减少药物性肾功能损害和必要时行CRRT治疗是肝移植围术期防治ARF的重要步骤.

Prophylaxis and management of early acute renal failure after orthotopic liver transplantation

Objective To summarize the experiences of prophylaxis and management of early period acute renal failure(ARF)after orthotopic liver transplantation(OLTx).Methods The clinical data of 516 patients from January 2004 to December 2006 at our hospital undergoing allograft orthotopic liver transplantation.41 8 males and 98 females,aged 43(8-76)years old,were collected to analyze the incidence of early ARF.Results Of these patients,106(20.5%)experienced early ARF,including 21 mild,40 mederate and 45 severe cases.The integrated control treatment including retrieving prerenal factors,adjusting immunosuppressive schedule,drug therapy and blood purification were taken to cure ARF and 21 patients of severe ARF needed continuous renal replacement therapy(CRRT).Of 106 patients,37 (34.9%)died within 1 month post-OLT.The one month post-OIX survival rate of patients with MELD (model for end-stage liver disease)score Iess than 20 fared better than thase whose MELD score between 20 to 30 and MELD score over 30.Conclusion The prophylaxis and management of early post-OLT ARF is a systemic procedure from preoperative assessment to postoperative management.The significant steps of preventing and curing ARF within perioperative procedure of OLTx include preoperative evaluation of patient renal function.various intra-operative measures for protecting renal function.reducing renal funotion impairment due to drug toxicity after OLT and CRRT treatment if needed.