重型肝炎和肝癌肝硬化患者肝移植围手术期肾功能的变化  

Changes in renal function in patients with severe hepatitis and liver cancer with cirrhosis during orthotopic liver transplantation

作　　者：李晓芸[1] 黑子清[1] 黎尚荣[1] 沈宁[1] 

机构地区：[1]中山大学附属第三医院麻醉科,广东广州510630

出　　处：《中国危重病急救医学》2007年第7期386-389,共4页Chinese Critical Care Medicine

基　　金：国家自然科学基金资助项目（30271254）;广东省科技计划基金资助项目（2004B35001005）

摘　　要：目的 观察重型肝炎及肝癌肝硬化患者原位肝移植围手术期肾功能变化,评价肝移植术对该类患者肾功能的影响。方法 选择30例术前血肌酐（SCr）、尿素氮（BUN）正常的终末期肝病、行背驮式原位肝移植术患者,手术过程中均未采用体外静-静脉转流。按原发病不同分为重型肝炎组（15例）和肝癌肝硬化组（肝癌组15例）,分别于术前（麻醉后）、无肝前20min、无肝30min、新肝60min、术毕不同时间点取桡动脉血,测定β2-微球蛋白（β2-MG）值,并记录血流动力学变化;分别于术前、新肝60min、术毕留取新鲜尿液,测定尿β2-MG及尿N-乙酰-β-D-葡萄糖苷酶（NAG）值。记录两组患者术前、术后24h、术后1周的SCr、BUN值以及术后肝移植相关性肾功能衰竭（肾衰）的发生情况。结果1术前重型肝炎组有7例血β2-MG、12例尿β2-MG、14例尿NAG值均高于正常参考值;而肝癌组仅有3例血β2-MG、3例尿β2-MG、7例尿NAG值高于正常参考值;两组各时间点血β2-MG异常率比较差异均无显著性（P均〉0.05）;重型肝炎组术前尿β2-MG及NAG异常率明显高于肝癌组（P〈0.01和P〈0.05）。2术中两组血β2-MG值与术前比较变化不大,变化趋势两时间点间比较差异均无显著性;两组新肝期60min及术毕尿β2-MG及NAG均较术前呈增高趋势,但差异无显著性（P均〉0.05）,而重型肝炎组各时间点尿NAG值明显高于肝癌组（P〈0.05或P〈0.01）。3重型肝炎组肝移植相关性肾衰发生率为46.7%,而肝癌组无一例发生（P〈0.01）。结论 重型肝炎患者较肝癌肝硬化患者肝移植术后早期易发生急性肾衰,围手术期应注意肾功能保护。Objective To observe the changes in renal function in patients with severe hepatitis and liver cancer with cirrhosis during orthotopic liver transplantation（OLT）. Methods Thirty end -stage liver disease patients with normal blood urea nitrogen （BUN） and serum creatinine （SCr） undergoing OLT were studied. They were derided into two groups., severe hepatitis group （group H, n= 15） and liver cancer group （group C, n = 15）, and all the patients received modified piggyback liver transplantation without veno-venous bypass. During the operation, blood samples were drawn for the determination of serum β2-microglobulin （β2 -MG）, and the determination was performed at 5 following time points： before operation, 20 minutes before anhepatic phase, 30 minutes in anhepatic, 60 minutes after reperfusion, and the end of operation. Urine samples were collected for determination of urine β2 - MG and N - acetyl -β - D - glucosaminidase （NAG） at 3 time points., before operation, 60 minutes after reperfusion, and the end of operation. The values of SCr and BUN before operation, 24 hours after operation and 1 week after operation. The incidence of renal function failure after liver transplantation in the two groups were recorded respectively. Results ①in 7 patients. 12 patients and 14 patients whose serum β2 -MG, urine β2 MG and urine NAG were higher than normal values, respectively, in group H before operation, and in 3 patients, 3 patients and 7 patients whose serum β2 -MG, urine β2 -MG and urine NAG, respectively, were higher than normal values in group C before operation. The incidence of abnormal of urine β2 -MG and NAG in group H were significantly higher than those in group C （P 〈0.01, P 〈 0.05 respectively）, while there were no significant differences for the abnormal rate of serum β2 -MG at every time point between the two groups during operation （all P〉0. 05）. ②Compared with baseline, serum β2 -MG almost had no change in both groups. There were no significant differe

关 键 词：肝移植 肝炎 重型 肝癌 肾功能衰竭 急性 围手术期 肾功能 

分 类 号：R686[医药卫生—骨科学]