终末期肝病模型评分较高的良性终末期肝病患者肝移植疗效评价

目的 探讨终末期肝病模型(MELD)评分较高的良性终末期肝病患者的肝移植疗效.方法 回顾分析80例良性终末期肝病肝移植患者的资料,根据MELD评分的不同将患者分成两组,MELD评分≥30分的23例为高MELD评分组,MELD评分＜30分的57例为低MELD评分组.分别比较两组患者手术时间、术中无肝期、术中血液制品输入量、术后重症监护病房(ICU)治疗时间和受者1年存活率,同时比较死亡患者和存活患者的临床资料,寻找导致术后死亡的危险因素.结果 高MELD评分组的手术时间、术中血液制品输入量、ICU治疗时间以及术后3个月内的死亡率明显高于低MELD评分组,差异有统计学意义(P＜0.05),而术中无肝期和患者1年存活率,两组间的差异无统计学意义(P＞0.05).死亡者和存活者相比较,MELD评分的差异无统计学意义(P＞0.05),而术前机械通气、血清钠水平、持续性肝性脑病(重型)等方面的差异有统计学意义(P＜0.05).结论 对于良性终末期肝病患者,单纯依靠MELD评分不足以准确判断患者肝移植术后的生存状态,高MELD评分者也可获得较好的肝移植结果,术前严重的低钠血症、重度肝性脑病以及机械通气是除MELD评分以外影响患者术后生存状况的危险因素.

Therapeutic evaluation of the patients with high MELD scores undergoing liver transplantation for benign end-stage liver disease

Objective To analyze the impact of a model for end-stage liver disease(MELD)score≥30 on one-year survival after orthotopic liver transplantation(OLT).Methods The data of 80 cases of benign end-stage liver diseases undergoing liver transplantation from Jaa 2004 to Jaa 2008 were retrospectively analyzed.MELD scores were examined before OLT,and the patients were divided into two groups according to their MELD scores:group 1,MELD≥30(n=23),and group 2,MELD ＜30(n=57).Operative time,anhepatic phase,intraoperative blood products transfusion,intensive care unit(ICU)stay,and one-year survival were compared between two groups.Results The operative time and ICU were prolonged,and intraoperative blood products transfusion was increased significantly in group 1 as compared with those in group 2(P＜0.05),but there was no significant difference in anhepatic phase and one-year survival between two groups.There was significant difference in serum sodium,serious hepatic encephalopathy and ventilation before OLT between deaths and survivors(P＜0.05)Conclusion In patients with end-stage liver diseases,serum sodium,serious hepatic encephalopathy and ventilation before liver transplantation may have prognostic values in addition to the MELD score for prediction of mortality in patients with high MELD scores.