肝移植相关性肾功能衰竭术中危险因素分析

目的探讨肝移植手术过程中引起肝移植相关性肾功能衰竭的危险因素。方法选择术前无明显肾功能损害的肝脏移植手术患者53例，分别于术中及术后抽取血标本进行血肌酐及尿素氮的测定，并根据Rimola等的诊断标准分为肝移植相关性肾功能衰竭组和非肾功能衰竭组。记录手术时间、无肝期时间，术中出血量、输血量，多巴胺、去甲肾上腺素、肾上腺素用量及术中是否发生低血压、是否发生肝缺血再灌注后综合征，对以上数据进行单因素及逐步回归分析，确定术中危险因素。结果术后1周内共有14例发生急性肾功能衰竭，单因素分析表明术中无肝期时间、出血量、血制品输入量、去甲肾上腺素用量以及低血压事件，两组间差异有统计学意义。经单因素及逐步回归分析，无肝期时间长（≥60min）是术后早期发生肝移植相关性肾功能衰竭的独立危险因素。结论肝移植术中无肝期时间≥60min是术后早期肝移植相关性肾功能衰竭的独立危险因素。缩短无肝期、减少术中出血、增加组织灌注压有利于减少肝移植相关性肾功能衰竭的发生，提高手术成功率及患者生存率。

Risk factors of acute renal failure associated with liver transplantation during operation

Objective To study the risk factors of renal failure associated with liver transplantation （RFALT） during orthotopic liver transplantation （OLT）. Methods 53 patients without renal disfunction undergoing OLT were studied. Blood samples were drawn for determination of creatinine and blood urea nitrogen during operation and after operation. Then they were divided into two groups according the standard of Rimola et al： patients with RFALT and patients without RFALT. Nine variables were recorded and analyzed with univarite analysis and stepwise logistic regression to identify the risk factors. Results 14 patients were diagnosed as RFALT a week after operation. Univarite analysis indicated that five variables, including duration of anhepatic phase, volume of intraoperative blood-loss, volume of intraoperation blood transfusion, low blood pressure and the concentration of norepinephrine had significant difference between two groups. The stepwise logistic regression analysis for 5 variables demonstrated that duration of anhepatic phase （≥60 min） was the independent risk factor of acute renal failure during OLT. Conclusion Duration of anhepatic phase≥60 min was the independent risk factor of acute renal failure during OLT, Shorten the duration of anhepatic phase, decrease the volume of intraoperation blood transfusion and increase infusion of renal in order to decrease RFALT.