胆道闭锁患儿亲体肝移植术后急性肺损伤风险因素分析

目的 分析胆道闭锁患儿亲体肝移植术后急性肺损伤的风险因素.方法 收集天津市第一中心医院2012年5月至2016年3月实施的112例胆道闭锁患儿亲体肝移植术临床资料,回顾性分析临床因素对患儿术后急性肺损伤的影响.结果 112例胆道闭锁患儿亲体肝移植患儿术后23例发生急性肺损伤,发生率为20.5％.单因素logistic回归分析显示肺部并发症组与对照组间年龄(P=0.010)、术前白蛋白(P=0.012)、术前总胆红素(P=0.001)、术前血清肌酐(P＜0.001)、术后1周内总胆红素峰值(P=0.035)差异有统计学意义(P＜0.05).多因素logistic回归分析显示,术前白蛋白(P=0.010,OR=0.830,可信区间为0.720～0.957)、术前总胆红素(P=0.001,OR=1.010,可信区间为1.004～1.016)及术前血清肌酐(P=0.001,OR=1.237,可信区间为1.104～1.387)是术后急性肺损伤发生的高危因素.结论 急性肺损伤是胆道闭锁患儿亲体肝移植术后的严重并发症,术前血清白蛋白、总胆红素及肌酐水平是患儿急性肺损伤发生的高危风险因素.

Risk factors for acute lung injury in living donor liver transplant recipients with biliary atresia in children

Objective To explore the risk factors of acute lung injury in pediatric living donor liver transplant recipients with biliary atresia (BA).Methods The clinical data were retrospectively reviewed for 112 BA children undergoing living donor liver transplantation from May 2012 to March 2016.And the risk factors of acute lung injury after living-donor liver transplantation were analyzed.Results Twenty-three children (20.5％) developed acute lung injury after transplantation.Univariate analysis showed that acute lung injury was associated with age (P =0.010),pretransplant albumin (P =0.012),pretransplant total bilirubin (P =0.001),pretransplant creatinine (P ＜ 0.001) and postoperative bilirubin peak (P =0.035).And multivariate analysis indicated that pretransplant albumin (P =0.006,OR =0.813,confidence interval 0.701 to 0.942),pretransplant total bilirubin (P =0.001,OR =1.010,confidence interval 1.004 to 1.016) and pretransplant creatinine (P =0.001,OR =1.237,confidence interval 1.104 to 1.387) were risk factors for acute lung injury after transplantation.Conclusions Pretransplant albumin,pretransplant total bilirubin and pretransplant creatinine are prognostic risk factors for acute lung injury after living-donor liver transplantation in children.