急性肝功能衰竭患者肝移植术后急性肾功能衰竭的病因分析及综合治疗  

Acute renal failure in acute Hver failure patients undergoing liver transplantation

作　　者：邢同海[1] 彭志海[1] 张政[1] 徐琴君[1] 陈国庆[1] 徐军明[1] 钟林[1] 孙星[1] 

机构地区：[1]上海交通大学附属第一人民医院普通外科上海市器官移植临床医学中心,200080

出　　处：《中华普通外科杂志》2008年第7期496-499,共4页Chinese Journal of General Surgery

基　　金：上海市科学技术发展基金项目资助（024119602）

摘　　要：目的分析急性肝功能衰竭（acute liver failure，ALF）患者肝移植术后肾功能衰竭的原因，评价以持续肾脏替代治疗（continuous renal replacement therapy，CRRT）为基础的综合疗法的疗效。方法回顾性分析2001年1月至2006年6月在我院施行的412例肝移植资料，根据UNOS肝功能分级标准筛选出54例ALF患者（UNOS1和2A），其中17例移植术后出现急性肾功能衰竭（acute renal failure，ARF）。在CRRT治疗基础上，进行抗排斥、抗感染、营养支持等治疗，并对患者围手术期情况、术后并发症、死亡原因及随访结果进行了分析。结果CRRT治疗过程中无并发症发生。无ARF组围手术期死亡率为5．4％，术后并发症发生率为35．1％，1、3年生存率分别为89．2％和81．1％。ARF组围手术期死亡率为58．8％，术后并发症发生率为100％，1、3年生存率分别为41．2％和41．2％。结论肝移植效果主要取决于肝外器官功能和术前肝功能状态。ALF患者围手术期死亡率较高，其中术前血肌酐高术后出现ARF率高，死亡率更高。以CRRT为基础的综合疗法能有效治疗ARF患者。Objective To investigate the causes of acute renal failure （ARF） after orthtopic liver transplantation （OLT） in patients of acute liver failure （ALF） and the effects of systemic therapy based on continuous renal replacement （CRRT）. Methods Clinical data of 412 patients who underwent liver transplantations between January 2001 and June 2006 were analyzed retrospectively （ all the cases were followed up to June 2007 ）. According to UNOS grading scale, 54 patients were of acute liver failure （ UNOS 1 and 2A）. Posttransplant ARF developing in 17 cases underwent a systemic therapy based on CRRT as well as anti-rejection, anti-infection and nutrition support. The perioperative courses, complications, causes of death and follow up results were analyzed. Results There were no severe complications during CRRT. Perioperative mortality was 5.4% and 58.8% in patients without ARF and those with ARF respectively, the rate of complications was 35.1% vs 100%, 1 year survival rate was 89. 2% vs 41.2%, 3 year survival rate was 81.1% vs 41.2%. Conclusions The effect of surgery mainly depends on the function of liver and other vital organs. The ALF recipients suffered from a high perioperative mortality, especially those with posttransplant ARL. The systemic therapy based on CRRT benefits patients with postoperative ARF.

关 键 词：肝移植 肝功能衰竭 急性 肾功能衰竭 急性 持续肾脏替代治疗 

分 类 号：R686[医药卫生—骨科学]