肝硬化患者肝移植术中红细胞输注影响因素

目的通过对资料回顾性分析，确定影响肝硬化患者肝脏移植术中红细胞输注因素。方法收集本院2003-2010年肝脏移植中肝硬化患者的临床资料328例，根据红细胞输注量将移植受体分为无红细胞输注组、一般输注组（8I细胞输注量〈12单位）和大量输注组（红细胞输注量≥12单位）3组，比较各组患者资料，并通过逐步回归分析选择预示术中红细胞输注指标。结果术中红细胞输注量与患者ChildPugh评分和MELD评分相关（相关系数分别为0．287和0．250，P〈0．01），不同红细胞输注组的年龄、ChildPugh评分、MELD评分、术前白蛋白、前白蛋白、血红蛋白、总胆红素水平和凝血酶原时间的差异有统计学意义，年龄、ChildPugh评分、术前前白蛋白、血红蛋白、总胆红素和肌酐水平对术中红细胞输注量有预示作用。结论患者术前的肝肾功能是影响肝硬化患者肝脏移植术中红细胞输注量的重要因素，其中肝脏合成功能受损作用更强。

Factors Influence Intraoperative Blood Transfusion in Patients with Cirrhosis underwent Liver Transplantation

Objective To define the factors related intraoperative blood transfusion in patients with cirrhosis under- went liver transplantation by retrospective data analysis. Methods We collected clinical data of 328 patients with cirrho- sis, who received liver transplantation in our hospital from 2003 to 2010. According to the amount of red blood cell trans- fusion, patients were divided into 3 groups： no transfusion group, routine transfusion group （the amount of RBC transfu sion less than 12 units） and massive transfusion group（the amount of RBC transfusion equal to or more than 12 units）. Clinical data were compared among groups and indexes which had predictive values for intraoperative blood transfusion, were selected by stepwise regression. Results The amounts of intraoperative blood transfusion were related with patientsr ChildPugh scores and MELD scores （r= 0. 287 and 0. 250, respectively）. There were significant differences among groups in patients＇ age, ChildPugh score, MELD score,preoperative serum albumin concentration, serum prealbumin concentra- tion, hemoglobin level, total bilirubin concentration, and prohrombin time. Age, ChildPugh scores, preoperative serum prealbumin concentration, hemoglobin level, total bilirubin concentration, and creatinine level had predictive values for in traoperative blood transfusion. Conclusion Patientrs liver and renal function significantly affect the amount of intraopera tive blood transfusion in patients with cirrhosis underwent liver transplantation. The impairment of patient＇s liver synthesis function has more effects.