原位肝移植术后发生脑病的相关因素分析

目的分析同种原位肝移植术后发生脑病的相关因素。方法回顾性分析128例次肝移植受者的临床资料,肝功能采用Child-Pugh分级,病情评估采用UNOS分级。对肝移植术后发生脑病的相关因素采用χ2检验、方差分析或t检验进行单因素分析,将有意义的因素纳入多因素模型Logistic回归进行分析。结果128例次肝移植术后共发生脑病21例(16.41%),其中Child-PughC级患者19例,B级2例;UNOS1级16例,2级以上5例;脑病大多发生于术后1周内,慢性重型肝炎及二次肝移植受者发生率较高(P<0.05)。Child-PughC级患者中未发生脑病44例(对照组),发生脑病19例(脑病组),两组在术前总胆红素、感染、肝移植手术方式、术后血清肌酐水平、感染以及肾功能衰竭的发生率等方面比较,差异有统计学意义(P<0.05);上述临床因素经多因素模型进行两分类反应变量的Logistic回归(前进法)分析后显示,术后肾功能衰竭和手术方式两项与发生脑病有显著关系(P<0.01)。结论肝移植术后脑病的发生是综合因素的结果,术前肝功能情况较差(Child-PughC级)以及病情危重(UNOS1级)的患者,术后脑病的发生率较高。术后急性肾功能衰竭与脑病的发生密切相关。

Encephalopathy in the patients subject to orthotopic liver transplantation: report of 128 cases

Objective To investigate the related factors of encephalopathy following orthotopic liver transplantation (OLT).Methods The clinical data of 128 patients who underwent liver transplantation consecutively between October 2001 and October 2003 were analyzed retrospectively by SPSS 10.0 . All clinical factors were analyzed by Crosstabs or independent-samples t test. A mutivariative analysis of these significant factors was done by using the Binary Logistic Regression.Results Encephalopathy occurred in 21 cases within the first week after operation, including 19 cases of Child-pugh C and 2 cases of Child-pugh B. There was a higher occurrence in the patients with chronic severe hepatitis or undergoing re-transplantation ( P < 0.05 ). In 63 cases of Child-Pugh C, encephalopathy occurred in 19 cases (encephalopathy group) and the remaining 44 cases had no encephalopathy (control group). There was no significant difference between two groups in age, sex, ALT and Cr before operation, the occurrence of pretransplantation variceal bleeding, hepatic encephalopathy and renal failure, operative time, bleeding and transfusion capacity during operation, time of nonhepatic phase, TB, ALT and electrolyte after operation and the blood concentration of FK506 ( P > 0.05 ). In the encephalopathy group the incidence of renal failure after transplantation and infection pre- or postoperation was higher than in control group ( P < 0.05 ). There was significant difference between two groups in surgical procedures, TB and Cr before operation ( P < 0.05 ). Multiple logistic regression analysis revealed that post-transplantation renal failure and surgical procedures wee independent predictors of encephalopathy for the patients with Child-pugh C level ( P < 0.05 ). By the way, the time staying in the ICU in the encephalopathy group was significantly prolonged as compared with that in the control group ( P < 0.01 ).Conclusions Encephalopathy following OLT was contributed to the comprehensive causes. The patients with worse hepatic function and severe disease conditions before transplantation had a higher incidence of encephalopathy after operation. The post-transplantation renal failure was closely correlated with encephalopathy. The pre-transplantation TB, infection before and after transplantation might have effects on the occurrence of encephalopathy.