MELD评分和CTP分级评估肝移植术后并发症及死亡风险的临床分析

目的应用MELD评分及CTP分级系统探讨影响肝移植术后并发症发生率和死亡率的高危因素。方法回顾性分析2008年1月到2013年1月收治的184例肝移植患者的临床资料,根据MELD评分分成3组,A组：≤10分;B组：〉10~20分;C组：〉20分。根据CTP评分分成3组,a组：5~6分,b组：7~9分,c组：10~15分。根据是否出现并发症和住院期间是否存活分为并发症组和非并发症组以及死亡组和存活组。结果 （1）A、B、C 3组主要临床指标在Cr、PT、PT-INR、TBIL、失血量、输血量、平均尿量上,差异有统计学意义（P〈0.05）。a、b、c 3组在ALB、PT、PT-INR、TBIL、失血量、输血量、平均尿量上,差异有统计学意义（P〈0.05）。（2）术前高总胆红素和术中输血量增加是肝移植术后发生并发症的高危因素（P〈0.05）。（3）术前PT升高、高MELD评分、术中输血量增加和平均尿量减少是肝移植术后围手术期死亡率增加的高危因素（P〈0.05）。结论 MELD分值和CTP分级越高,肝移植患者术后并发症的发生率和死亡率越高。术前高胆红素、术前凝血功能障碍和肾功能差是肝移植术后并发症及死亡率增加的高危因素。

Clinical analysis of post liver transplantation complications and the risk factors of death by MELDscore and CTP classification

Objective To investigate the risk factors of complications and mortality rate after liver transplantation by MELD score and CTP classification. Methods The clinical data of 184 patients undergone liver transplantation were retrospectively analyzed. Patients were divided into three groups respectively according to MELD score and CTP score： group A（MELD ≤ 10）,B（MELD 10-20）,C（MELD 20）and group a（CTP 5-6）,b（CTP 7-9）,c（CTP 10-15）. Patients were also divided into compli-cations and non-complications group,survival group and death group. Results（1）Clinical indicators of the three groups A,B,C had significant differences in Cr,PT,PT-INR,TBIL,intraoperative average urine volume,intraoperative blood transfusion and blood loss（P0.05）; while the three groups a,b,c showed significant differences in ALB,PT,PT-INR,TBIL,intraoperative average urine volume,intraoperative blood transfusion and blood loss（P0.05）.（2） Hyperbilirubinemia,improper coagulation function and renal function before the operation were the risk factors for complications after liver transplantation.（3） Increased PT,high MELD score,increased intraoperative blood transfusion and decreased intraoperative average urine were the risk factors for death during the perioperative period. Conclusions The higher the MELD score and CTP score,the higher the incidence of complications and mortality rate after liver transplantation. Hyperbilirubinemia,poor coagulation function and renal function are the most important risk factors for complications and mortality rate after liver transplantation.