肝移植术后早期急性肺水肿14例临床相关因素分析

目的 探讨肝移植术后早期急性肺水肿的临床相关因素，为临床合理处理提供线索。方法观察我院行肝移植术后急性肺水肿14例患者的术前终末期肝病模型（MELD）评分、手术前后肾功能（尿量、血肌酐）的变化情况；记录移植术中及术后前3d总入量、总出量和液体平衡量。结果肝移植术后急性肺水肿患者（14例）术前MELD评分较非肺水肿组（127例）显著增高（P〈0．01），且术后死亡率明显上升（P〈0．01）；急性肺水肿患者术前存在肾功能不全，术后血肌酐、尿量延迟恢复；术中、术后液体正平衡显著增加，与非肺水肿组差异均有统计学意义（P〈0．01）。结论肝移植术后早期急性肺水肿与术前高MELD分值、术前肾功能障碍、术后肾功能延迟恢复及术中大量输液、术后限液不足密切相关，术中、术后严格控制出入量平衡，尽快恢复患者肾功能及相关重要脏器支持是防止肝移植早期急性肺水肿的有效措施。

Analysis of the clinical factors related to early acute pulmonary edema after liver transplantation

Objective To investigate the clinical risk factors related to early acute pulmonary edema after liver transplantation for further effective treatment. Methods For the 14 patients with acute pulmonary edema after liver transplantation, model for end stage liver disease （MELD） score was taken just before the operation. Changes of renal function（urine volume and serum creatinine） perioperatively, operative and postoperative total intake volume, output volume and fluid balance were recorded. Results Both preoperative MELD scores and postoperative mortality of the patients with acute pulmonary edema （n = 14） were significantly higher than that of non edema group （n = 127, P〈 0.01 ）. Postoperatively recovery of serum creatinine and urine volume delayed in the patients with acute pulmonary edema and preoperative renal dysfunction. Moreover, the rate of positive operative and postoperative fluid balance in the patients with acute pulmonary edema significantly increased than that of non-edema group （P〈0.01）. Conclusion Preoperative high MELD score, preoperative renal dysfunction and postoperative delayed recovery of renal function, operative and postoperative large volume of transfusion were the risk factors of early acute pulmonary edema after liver transplantation, corresponding treatment against these risk factors should be the key to decrease incidence of acute pulmonary edema after liver transplantation.