不同MELD评分患者术前临床特征及MELD评分对肝移植术中循环调控的影响

目的探讨不同MELD评分患者术前的临床特征及MELD评分对终末期肝病病人肝移植手术中循环调控的影响．方法124例2004年1月至12月在加州大学洛杉矶分校医疗中心行肝移植手术病人，根据术前患者MELD评分分为2组，MELD≤30为低MELD评分组，MELD〉30为高MELD评分组，比较两组患者术前临床资料、实验室生化指标和术中输血量及升压药使用情况．结果术前凝血酶原时间国际标准化比值（INR）、血清肌酐、血球压积和纤维蛋白原两组间差异有显著性，高MELD评分组术前气管插管机械通气及使用升压药更常见，术中输血量及升压药使用率明显增加．结论高MELD评分患者术前病情较重，术中有较多的并发症，需更严密的麻醉监测和管理．

MELD Scores on Regulating Circulation in Liver Transplantation

Objective To investigate preoperative characteristics of patients with different MELD scores and effects of MELD scores on regulating circulation in liver transplantation. Methods We retrospectively reviewed the records of 124 primary adult liver transplant patients. Patients were divided into low （≤ 30） and high MELD （ 〉 30） score groups. Preoperative characteristics and intraoperative management were compared between the 2 groups. Results There was statistic difference in INR, plsma creatinine, hematocrit, and fibrinogen levels between the 2 groups. Patients with high MELD scores were more likely to require ventilatory and vasopressor support before transplantation. Intraoperative transfusion requirements and use of vasopressors were also significantly increased in patients with high MELD scores. Conclusion Patients with higher MELD scores have more serious condition before operation, more complications during liver transplantation, and require stricter anesthetization surveillance.