肝移植术后早期肾功能衰竭的危险因素分析  

Risk factors of renal failure in early period after liver transplantation

作　　者：张小进[1] 江艺[1] 吕立志[1] 胡还章[1] 杨芳[1] 蔡秋晨[1] 

机构地区：[1]南京军区福州总医院肝胆外科中心,福州350025

出　　处：《中华肝胆外科杂志》2008年第1期31-33,共3页Chinese Journal of Hepatobiliary Surgery

摘　　要：目的分析南京军区福州总医院肝移植术后早期肾功能衰竭的危险因素，探讨其防治策略。方法回顾分析该院72例肝移植病人的临床资料，包括年龄、性别、等待供肝时间、术前肝功能Child分级、血清肌酐水平、肾动脉阻力指数、血清总胆红素水平、PT、APTT，术中失血量、补液量、低血压总时间、腔静脉完全阻断时间、是否应用经典原位肝移植、是否使用人工肝等，并进行多因素分析，寻找术后早期肾功能衰竭的危险因素。结果18例术后发生早期肾功能衰竭，发生率为25％；术前肌酐水平升高、肾动脉阻力指数增大、术中大量失血、术中低血压时间长、术中补液量大以及未使用术中人工肝等因素为早期肾功能衰竭的高危因素。结论术前尽可能改善肾功能，术中尽量减少出血，维持血流动力学稳定，充分发挥术中人工肝持续血液滤过的作用，可有效降低肝移植术后早期肾功能衰竭的发生。Objective To analyze the risk factors of renal failure in the early period after liver transplantation. Methods The clinical data of 72 patients receiving liver transplantation in our hospital from December 1999 to May 2005 were retrospectively analyzed. Many factors such as ages, genders, how long waited for donor liver, hepatic function called Child-Pugh C, serum creatinine level, renal arterial resistive index,PT, APTT and serum total bilirubin before operation,the bleeding volume, the amount infused fluid,how long clamping vena cava lasted, total hypotension time and whether the patient underwent orthotopic liver transplantation, or used artificial liver during operation etc. were determined. Results Of the 86 patients, 18 （25 %） developed acute renal failure in the early postoperative period. Multi-factor analysis revealed a high serum creatinine level and renal arterial resistive index Before transplantation, the massive bleeding volume, a long total hypotension time, the massive amount infused fluid and unused artificial liver during operation were risk factors for development of ARF. Conclusion Improvement of renal function before transplantation, decrease of bleeding volume and maintaining stable hemodynamics,reasonable apply of artificial liver are effective measures to prevent ARF in the early period after liver transplantation.

关 键 词：肝移植 肾功能衰竭 危险因素 防治策略 

分 类 号：R657.3[医药卫生—外科学]