肝移植术后弥漫性脑病的特点及危险因素分析

目的探讨肝移植术后弥漫性脑病(diffuse encephalopathy,DEP)的临床特征、影响因素、防治措施及预后。方法回顾性分析187例原位肝移植的临床资料,以术后发生DEP者为Ⅰ组,无DEP者为Ⅱ组,比较两组各项临床参数。结果肝移植术后DEP发生率13.37%。术前Ⅰ组和Ⅱ组慢加急性肝衰竭占48.0%和18.5%(P<0.01);肝功能Child C级占88.0%和65.4%(P<0.05);终末期肝病模型评分为(22.83±10.54)和(13.24±11.36)(P<0.05);总胆红素为(348.6±244.8)μmol/L和(174.3±134.2)μmol/L(P<0.01);血氨为(67.9±24.7)μmol/L和(39.7±14.8)μmol/L(P<0.05)。术中Ⅰ组和Ⅱ组出血量分别为(4108±1513)ml和(3112±1260)ml(P<0.05);平均动脉压<70mmHg例数占92.0%和64.8%(P<0.05);低血压持续时间为(12.4±6.4)min和(7.5±4.6)min(P<0.05);术后Ⅰ组和Ⅱ组病死率为16.0%和4.94%(P<0.05)。结论肝移植术后DEP与原发病种类及严重度、术中出血量及低血压持续时间、术后免疫抑制剂血药浓度等显著相关。

Features of diffuse encephalopathy after liver transplantation and its risk factors

Objective To investigate the clinical features, influencing factors, prevention measures and prognosis of diffuse encephalopathy （DEP） in patients with orthotopic liver transplantation （OLT）. Methods 187 patients with OLT were divided into group I with DEP and group 11 without DEP ,and their clinical parameters were retrospectively analyzed. Results Patients of group I accounted for 13.37% of the whole. Be- fore OLT, the percentage of patients in group I and Ⅱ diagnosed as acute on chronic liver failure were 48.0% and 18.5% respectively （ P 〈0.01）. Patients of Child C accounted for 88.0% and 65.4% respectively （P 〈 0.05）. Model for end-stage liver disease score was （22.83 ± 10.54） and （ 13.24 ± 11.36） （P 〈0.05）. Total serum bilirubin was （348.6 ± 244.8 ） μmol/L and （ 174.3 ± 234.2） μmol/L （ P 〈 0.01 ）. Serum ammonia was （67.9 ±24.7）μmol/L and （39.7 ±± 14.8）μmol/L （P 〈0.05）. During the OLT operation of group I and II,the volume of blood loss was （4108 ± 1513） ml and （3112 ± 1260） ml （P 〈0.05）. Patients with the MAP less than 70 mmHg were 92.0% and 64.8% （ P 〈 0.05 ）, and the duration of hypotension persisted for （ 12.4 ± 6.4） min and （7.5 ± 4.6） min respectively （ P 〈 0.05 ）. After the OLT operation of group I and II, the mortality was 16.0% and 4.94% respectively （ P 〈 0.05）. Conclusion Liver transplantation postoperative DEP associ- ated with primary disease type and severity, amount of intraoperative bleeding and hypotensive duration, the blood concentration of , significant correlation.