肝移植围手术期液体治疗的临床研究

目的 探讨肝移植围手术期的液体治疗与术后早期预后的关系,为肝移植围手术期合理的液体治疗提供依据.方法 回顾性分析1996年7月至2005年12月的62例肝移植受者资料,根据术后早期是否有肺部并发症(包括肺水肿、急性肺损伤、肺炎、急性呼吸窘迫综合征),将受者分为有并发症组和无并发症组.应用单因素分析比较两组受者围手术期中的23项参数,然后进行logis-tic多因素回归分析,筛选出影响早期肺部并发症的一些变量;并比较这些变量对术后恢复情况的影响.结果 有并发症组和无并发症组受者的23项参数比较发现:术前肺功能、术中入量、术中出血量、术中出入量差、术后第1天入量、术后第1天的液体平衡≤-14 ml/kg和术后第1天及术后3 d内的另1 d液体平衡均≤-14 ml/kg的差异有统计学意义.将有统计学意义的参数作为自变量、术后并发症作为因变量,进行logistic多因素回归分析,结果术前肺功能、术中出入量差>62 ml/kg、术后第1天入量≤44ml/kg和术后第1天及术后3 d内的另1 d液体平衡均≤-14ml/kg为影响术后早期肺部并发症的因素.结论 肝移植围手术期液体治疗中,术中和术后维持液体平衡是减少肝移植术后肺部并发症的重要措施,尤其是术后前3 d在血流动力学稳定的前提下,适当的液体负平衡有利于受者恢复正常.

The clinical study of perioperative fluid therapy for liver transplantation

Objective To investigate the correlation between perioperative fluid therapy and ear-ly pulmonary complications after liver transplantation, and provide a reasonable fluid therapy in the perioperative period of liver transplantation. Methods Sixty-two patients undergoing liver transplan-tation at the First Affiliated Hospital of Guangxi Medial University from July 1996 to December 2005 were enrolled and analyzed retrospectively. Based on early phase prognosis after liver transplantation, the 62 patients were divided into the none-pulmonary complication group and the pulmonary complica-tion group (including pulmonary edema, acute lung injury, pneumonia and acute respiratory distress syndrome). Twenty-three perioperative variables in both groups were analyzed by monofaetorial analysis and logistic multivariate regression analysis to screen out several variables affecting the early pul-monary complications, and the parameters reflecting postoperative recovery were analyzed in these var-iables. Results Using monofactorial analysis for each variable, there were significant differences be-tween the two groups in the following variables: preoperative lung function; the volume of intraopera-tire transfusion (ml/kg) ; the volume of intraoperative bleeding (ml/kg) ; the volume of intraoperative net fluid retention (ml/kg) ; the transfusion volume at the first day after operation (ml/kg) ; fluid bal-ance (≤ - 14 ml/kg) at the first day after operation and fluid balance (≤- 14 ml/kg) at the first and another days of the first 3 days after operation. Analysis of the relationship between multivariate fac-tors and pulmonary complication after liver transplantation by logistic multivariate regression analysis revealed that preoperative lung function, the volume of intraoperative net fluid retention (ml/kg), the transfusion volume at the first day after operation (ml/kg) and fluid balance (≤- 14 ml/kg) at the first and another days of the first 3 days after operation were influential factors. Conclusions It is im-portant to maintain fluid balance during the perioperative period of liver transplantation. If haemody-namics is stable, appropriate negative fluid balance at the first 3 days after operation apparently de-crease the incidence of early pulmonary complications after liver transplantation. These measures were associated with better postoperative recovery.