肝移植术后急性肺损伤的危险因素分析

目的 总结62例肝移植患者的临床资料，回顾性分析术后急性肺损伤（acute lung injury，ALI）发生的危险因素。方法 按ALI的诊断标准，将62例患者分为急性肺损伤组（ALI组）和非急性肺损伤组（NO—ALI组），比较两组的年龄、性别、原发病因、手术方式及预后。单因素、Logistic回归分析肝移植术后ALI发生的危险因素。结果 两组患者年龄、性别、原发病因及手术方式无明显差别。12例ALI发生在术后1d至4周，3例死亡。单因素分析发现，术后肺部感染、术中及术后的门肺高压、术中输血量、术中补液量、术后再次开腹、术后急性肾功能衰竭、术后激素冲击治疗对ALI的发生有显著影响。回归分析提示，术后肺部感染、术中及术后的门肺高压是ALI发生的危险因素。结论 术后肺部感染、术中及术后的门肺高压是肝移植术后ALI发生的危险因素，重视上述因素对预防与减少ALI的发生具有较重要的临床意义。

Risk factors for acute lung injury after liver transplantation

Objective To analyze risk factors for acute lung injury(ALI)after liver transplantation.Methods According to whether or not ALI develops posttransplantation,62 patients were divided into ALI group and NO-ALI group.Age,gender,primary diagnosis,operative pattern and outcomes between the two groups were compared.Monofactor analysis and logistic regression methods were adopted to evaluate the perioperative risk factors for ALI.Results There was no significant difference in age, gender,primary diagnosis and operative pattern between the two groups,but there was a higher mortality in ALl patients.In this study,ALI developed from 1 d to 4 w postoperatively.Monofactor analysis showed that ALI was significantly correlated with postoperative pulmonary infection,portopulmonary hypertension, intraoperative over-transfusion,intraoperative liquid overload,postoperative relaparotomy,acute renal failure,high dose methylprednisolone.Logistic regression revealed that postoperative pulmonary infection and pertopulmonary hypertension were risk factors for ALI.Conclusions Postoperative pulmonary infection and portopulmonary hypertension were risk factors leading to posttransplantation ALI.