肝移植术后患者急性肺损伤及其早期危险因素分析

目的 观察原位肝移植(OLT)术后患者早期急性肺损伤(ALI)的发生情况,分析其相关的早期危险因素.方法 采用成组设计的病例-对照研究方法 .2004年11月至2006年6月中山大学附属第三医院91例接受OLT的患者,术前明确疾病种类并进行肝功能分级,术中观察并记录手术时间、出入量等指标,术后连续追踪14 d观察急性肺损伤发生情况.对各种因素进行单因素及多因素分析,多因素分析采用Logistic(Forward法)逐步回归.结果 53例术后出现呼吸系统并发症,发病率为58.2%,其中25例发生ALI,发病率为27.5%.单因素分析显示高龄、重型肝炎、术前高血清胆红素、低凝血酶原活动度、高Child及MELD评分、术中失血多、输血多是OLT术后发生ALI的高危因素(均P<0.05),Logistic逐步回归分析筛选出胆红素是影响术后ALI发生的独立的早期危险因素.结论 OLT术后早期ALI的发病率为27.5%,术前高血清胆红素是术后ALI的重要早期危险因素.

Early risk factors of acute lung injury following orthotopic liver transplantation

Objective To analyze the early risk factors of acute lung injury (ALI) following orthotopic liver transplantation (OLT). Methods Ninety-one patients with end-stage liver disease, 79 males and 12 females, underwent OLT. The general condition, serum total bilirubin, albumin, creatinine, and prothrombin activity, Child-Turcotte-Pugh(CTP) score, and model for end-stage liver disease (MELD) score 48 h before operation were recorded. The operation time, cold ischemia time of donor's liver, time of anhepatic phase, ascitic fluid, blood loss, RBC infusion amount, crystal infusion, and total infusion during operation were recorded too. Follow-up was conducted for 14 days to observe the clinical manifestation, and time of ventilatory support, arterial blood gas analysis and radiological examination of chest were performed. Univariate analysis and logistic stepwise regression analysis were done to investigate the early risk factors of ALI. Result 53 patients (58.2%) suffered from pulmonary complications following OLT, including ALI (27.5%) and adult respiratory distress syndrome (ARDS) (5.5%). Univariate analysis showed that preoperative senior age, severe hepatitis B, high serum total bilirubin, low prothrombin activity, and high CTP and MELD scores, and large amount of blood loss and RBC infusion during operation were all risk factors of ALI following OLT (all P<0.05). Logistic stepwise regression analysis screened out serum total bilirubin as an independent predictor for ALI following OLT. Conclusion A little more than a quarter of the patients undergoing OLT develop ALI after operation. High preoperative serum total bilirubin is an important early risk factor for ALI following OLT.