1 510例成人原位肝移植患者围手术期的管理

目的 分析影响原位肝移植围手术期预后的因素及其临床对策，为提高肝移植患者围手术期综合治疗水平和肝移植术后的总体生存率提供依据。方法 回顾性分析天津市第一中心医院移植中心2000年1月-2005年6月治疗的1510例原位肝移植患者围手术期涉及术前、术中和术后的20项相关临床和实验室指标，筛选出影响围手术期预后的危险因素。结果 存活组和死亡组在急性生理学与慢性健康状况评分系统Ⅲ（APACHE Ⅲ）评分、术中输血量、术中组织氧供状态、术后感染发生率、术后肝功能状态、对血液净化治疗的需求等方面显示出有统计学意义的差异。结论 在肝移植围手术期监护治疗中，应针对影响肝移植围手术期预后的高危险因素进行综合防治。

Analysis of peri-operative management in 1 510 patients with orthotopic liver transplantation

OBJECTIVE: To study the clinical factors and treatment that related to early prognosis of patients after orthotopic liver transplantation (OLT), in order to improve peri-operative care and raise the survival rate in patients undergoing this operation. METHODS: Clinical records of 1,510 patients who had undergone OLT in our center were retrospectively analyzed. Twenty variables in pre-operative, intra-operative or post-operative periods were included, and several risk factors which affected the early prognosis after OLT were screened. RESULTS: With univariate analysis, the following variables showed significant difference between the survival group and the dead group: acute pathology and chronic health evaluation III (APACHE III) score, volume of transfusion and oxygen delivery (DO(2)) of tissue during operation, incidence of infection, and demand of blood purification. CONCLUSION: During peri-operative periods of OLT, combined therapy should be used, and attention should be paid to the risk factors.