肝移植术中输血量的预测因素分析

目的 分析成人终末期肝病(ESLD)患者肝移植术中输血量的术前预测因素.方法 回顾性总结我院肝胆外科2005年8月～2011年9月共63例肝移植受体的临床资料,统计其术中输血量,根据术中用血量≥12 U和＜12U分为2组,比较2组患者之间一般情况、术前实验室检查结果等各项指标的不同,分析其与肝移植患者输血量之间的关系.结果 63例肝移植术中,27名患者输血量≥12U.单因素分析显示肝移植术中输血量＞12U的术前预测因素为Hb、总蛋白、肌酐、MELD评分、既往上腹手术史；多因素分析结果显示术中输血量＞12 U的独立预测因素为Hb和既往上腹部手术史.预测模型为:y=4.31 +1.979×既往上腹部手术史-0.046×术前Hb.结论 成人终末期肝病患者肝移植术中输血量＞12U的独立预测因素为术前Hb和既往上腹部手术史,根据以上结果输血科可以预测用血数量和品种,合理选择血液制品并提供备血.

Predictors of massive blood transfusion in liver transplantation

Objective To identify the predictors of massive blood transfusion(MBT) in liver transplantation for patients with end-stage liver disease(ESLD).Methods Retrospective study of clinical data on all liver transplantations performed in the our hospital between August 2005 and September 2011.The patients were divided into 2 groups according to whether the amount of intraoperative total RBCs exceeded 12 units.The differences in general state of health,preoperative parameters between the two groups were compared and logistic regression analysis on the relationship between these parameters and the intraoperative massive transfusion was made. Results Among the 63 liver transplant recipients,27 received ≥12 units of RBC during the surgery.Logistic regression showed that the preoperative hemoglobin,total protein,serum creatinine,MELD score and previous upper abdominal surgery were risk factors of MBT.Multivariant logistic regression identified 2 independent predictors of MBT:hemoglobin and previous upper abdominal surgery.Preoperative score of massive transfusion in adult end-stage liver disease liver transplantation was y=4.31+1.979×previous upper abdominal surgery-0.046×hemoglobin. Conclusion MBT during liver transplantation can be predicted by hemoglobin and previous upper abdominal surgery.