肝移植围手术期肝肾综合征的综合治疗临床观察

目的探讨肝移植围手术期以特利加压素（terlipressin）为基础的综合治疗措施对改善HRS病人肾功能及提高术后生存率的作用。方法对术前16例及术后15例HRS病人采用以terlipressin为基础的综合治疗，观察治疗前后血Cr及24h尿量的变化以及术后ICU时间、感染率、急性肾衰发生率、死亡率等各项指标。结果单纯使用terlipressin治疗的病人，治疗前后的血Cr及24h尿量的变化差异有统计学意义（P〈0．05）；CRRT的使用能明显改善病人的临床症状；与同期行肝移植的非HRS病人相比，经综合治疗的HRS病人的ICU治疗时间较长、感染率较高（P〈0．05），但ARF的发生率及死亡率无显著性差异（P〉0．05）。结论对肝移植围手术期的HRS病人采用terlipressin结合CRRT及2剂赛尼哌诱导疗法的综合治疗可以明显改善病人的肾功能，提高生存率。

A clinical study on terlipressin-based comprehensive treatment for perioperative hepatorenal syndrome in liver transplantation

Objective To investigate the role of perioperative terlipressin-based comprehensive treatment in improving the renal function and survival rate of patients with hepatorenal syndrome(HRS) after transplantation.Methods Before and after liver transplantation,16 patients with preoperative HRS and 15 with postoperative HRS received the terlipressin-based comprehensive treatment.Meanwhile,the ICU stay,incidence of infection acute renal failure morbidity and mortality were determined in all 31 patients before and after the liver transplantation.Results In patients with HRS receiving terlipressin monotherapy,blood Cr and 24-h urine levels were significantly improved as compared with those before the treatment(P<0.05).The comprehensive treatment could markedly improve the symptoms in the patients.Compared with the patients without HRS,the patients with HRS receiving the comprehensive treatment had significantly higher ICU stay and infection rate(P<0.05).However,there were no remarkable differences in acute renal failure morbidity and mortality between the 2 groups of patients(P>0.05).Conclusions Perioperative terlipressin-based comprehensive treatment can effectively improve renal function to promote survival rate in patients with HRS.