经典非转流原位肝移植术后早期肾功能障碍的原因分析  

Causes for early postoperative renal dysfunction in classic orthotopic liver transplantation without venoveno bypass

作　　者：李鉴[1] 田鸣[1] 翁以炳[1] 雷志礼[2] 刘振文[3] 

机构地区：[1]首都医科大学附属北京友谊医院中心ICU,北京市100050 [2]中国武警总医院麻醉科 [3]中国武警总医院移植科

出　　处：《中华肝胆外科杂志》2006年第5期309-312,共4页Chinese Journal of Hepatobiliary Surgery

摘　　要：目的观察经典非转流原位肝移植(orthotopic liver transplantation,OLT)术后早期肾功能障碍(renal dysfunction,RD)发生的原因并提供临床参考。方法前瞻性研究了连续48例经典非转流 OLT 病例。根据术后早期(术后第1周)血清肌酐水平进行分组。对单因素分析后有显著性差异的资料进行多因素回归分析。结果经典非转流 OLT 术后早期 RD 的发生率为35.4%。BinaryLogistic 多元回归分析显示:术前 RD、Child-Pugh 评分、无肝期门静脉开放后1h 尿量是该术后早期RI)的危险因素。结论对于术前明显肾功能障碍或 Child-Pugh 评分较高的病人,应避免使用经典非转流术式。对于接受经典非转流手术的病人,术前应纠正肾功能异常;术中应避免血流动力学的剧烈波动,保持稳定有效的肾血流灌注,以减少术后早期 RD 的发生。Objective To determine the causes for postoperative renal dysfunction （RD） during the first week after classic orthotopic liver transplantation （OLT） without veno-veno bypass （VVBP）. Methods The clinical data of 48 consecutive adult patients receiving classic OLT without VVBP in our hospital were retrospectively analyzed. The patients were grouped based on the level of serum creatinine during the 1st week after OLT. The data that were statistically significant in univariate analysis were verified by multivariate analysis using binary logistic regression. Results The incidence of early postoperative RD after classic OLT without VVBP was 35.4%. The binary logistic regression analysis showed that preoperative renal dysfunction, Child-Pugh score, urine output during the anhepatic period and the 1st h after removal of clamp on portal vein were significantly correlated to early postoperative RD. Conclusions The patients with the history of apparent RD or higher Child-Pugh score should undergo other types of OLT rather than OLT without VVBP. Maintaining stable hemodynamics and sufficient renal blood perfusion may decrease the incidence of early postoperative RD in the patients undergoing OLT without VVBP.

关 键 词：肝移植 肾功能障碍 静脉-静脉转流 

分 类 号：R657.3[医药卫生—外科学]