肝移植术后早期急性肾功能衰竭的影响因素及其临床意义

目的 探讨肝移植术后早期急性肾功能衰竭(ARF)的相关危险因素.方法 对2000年8月至2010年12月收治的362例连续肝移植患者的临床资料进行回顾性分析,根据术后是否发生ARF,分为肾功能衰竭组(n=71)和无肾功能衰竭组(n =291).以围术期常用的临床及实验室指标共计36项作为危险因素的分析对象,先对这些指标进行单因素分析,再以单因素分析中P＜0.05的术后ARF影响因素为自变量进行Stepwise logistic回归分析.结果 在单因素分析中两组间差异有统计学意义的指标有术前血清肌酐、血红蛋白、凝血酶原活动度、总胆红素、MELD评分、总手术时间、术中出血量、输血量、术中尿量、术前有无肝性脑病、术中有无低血压及术后有无感染等指标,两组间的差异有统计学意义(F=10.30～182.70,P=0.000～0.041).对上述12项指标进行回归分析,发现术前高血清肌酐水平、低凝血酶原活动度水平、MELD评分、术中失血量多、术后合并感染与肝移植术后发生ARF密切相关(P＜0.05).结论 肝移植术后并发ARF的原因可能是多方面的,改善肝移植患者的术前状况是预防术后早期ARF的关键.血清肌酐水平高、凝血酶原活动度低、MELD评分、术中失血量多和术后合并感染是肝移植术后发生早期ARF的独立危险因素.

The influential factors and clinical significance of acute renal failure complicated to orthotopic liver transplantation

Objective To analyze the risk factors for acute renal failure (ARF)early after liver transplantation.Methods The data of 362 patients undergoing liver transplantation from August 2000 to December 2010 were retrospectively analyzed,including 71 patients with ARF( ARF group)and 291 without ARF (non-ARF group).Thirty-six variables,including clinical and experimental variables,were analyzed by t test for continuous variables and x2 test for discrete variables.The variables with significance ( P ＜ 0.05 ) were then analyzed with Stepwise logistic regression.Results Twelve variables,including pretransplant serum creatinine,hemoglobin,thrombinogen activity,total bilirubin,MELD scores,total operation time,intraoperative blood loss,intraoperative blood transfusion,preoperative urine output,preoperative hepatic encephalopathy,intraoperative low blood pressure and postoperative infection,had significant difference between two groups( F =10.30-182.70,P =0.000-0.041 ).The Stepwise logistic regression analysis for 12 variables demonstrated that the high level of pretransplant serum creatinine,the low pretransplant thrombinogen activity,the high MELD scores,the large volume of intraoperative blood loss,postoperative infection were the independent risk factors of ARF complicated to orthotopic liver transplantation( P ＜ 0.05 ).Conclusions Early ARF is a key negative factor for the survivors after orthotopic liver transplantation.The reason for ARF complicated to OLT is multiple.The high level of pretransplant serum creatinine,the low pretransplant thrombinogen activity,the high MELD scores,the large volume of intraoperative blood loss,postoperative infection were the independent risk factors of ARF complicated to orthotopic liver transplantation.