肾移植术后早期消化道出血的危险因素分析及治疗

目的 研究肾移植患者术后早期发生消化道出血的危险因素及治疗方法.方法 回顾性分析266例次肾移植术后1个月内消化道出血患者的临床资料,用单因素logistic回归分析发病的相关因素,并用多元逐步logistic回归方法分析导致肾移植术后消化道出血的高危因素.总结消化道出血的治疗方法.结果 本组术后消化道出血发生率为10.5%,多发生于肾功能延迟恢复（DGF）期间,甲泼尼松总量、肺部感染、肝素透析及直接血管穿刺是肾移植术后发生消化道出血的高危因素.出血组患者移植肾脏近期存活率显著低于未出血组患者.及时、持续的抑制胃酸分泌有利于消化道出血的治疗.结论 DGF是发生消化道出血的高危时期,导致发病的危险因素多,及时、彻底地控制出血,适当调整免疫抑制剂的用量,积极预防肺部感染,合理应用透析方法有助于患者安全.应用多元逐步logistic回归分析,有助于判断消化道出血发生风险,并进行针对性的临床干预.

Risk factors analysis and treatment of gastrointestinal hemorrhage in early stage of kidney transplantations

Objective To define clinical parameters associated with gastrointestinal hemorrhage in the early stage after renal transplantation,and to develop a series of effective methods to treat gastrointestinal hemorrhage. Methods Risk factors for gastrointestinal hemorrhage in 266 patients with renal transplantation were studied by a multivariable logistic regression analysis. The binary and multinomial logistic regression analysis was performed respectively to define the correlation factors and high risk factors of gastrointestinal hemorrhage after operation. The effective treatment for the gastrointestinal hemorrhage was also summarized. Results In this cohort the incidence of gastrointestinal hemorrhage was 10.5%. Most gastrointestinal hemorrhage occurred during delayed graft function （DGF） period. It was found that total dosage of methylprednisolone, pulmonary infection,heparin hemodialysis and blood vessel puncturation before hemodialysis were significantly associated with gastrointestinal hemorrhage, and the allograft survival was significantly affected by the occurrence of gastrointestinal hemorrhage renal transplantation. Conclusion The results suggest that gastrointestinal hemorrhage is prong to occur during the DGF period. Prompt management of hemorrhage, adequate adjustment of immunosuppressant and prophylaxis of pulmonary infection are needed to manage bleeding crises in recipients. The risk of gastrointestinal hemorrhage can be predicted with the help of logistic regression analysis. Therefore, relevant clinical intervention and optimal allocation decision can be conducted.