肝肺综合征患者肝移植预后的危险因素分析  

Risk factors predicting the prognosis of orthotopic liver transplantation in hepatopulmonary syndrome

作　　者：易慧敏[1] 蔡常洁[1] 陆敏强[1] 杨扬[1] 易述红[1] 汪根树[1] 张俊峰[1] 陈规划[1] 

机构地区：[1]中山大学附属第三医院肝移植中心,广州510630

出　　处：《中华外科杂志》2009年第17期1312-1315,共4页Chinese Journal of Surgery

基　　金：国家重点基础研究发展计划（973课题）资助项目（2003CD515507）;广东省科技计划资助项目（20088060600060）;广东省卫生厅资助项目（A2007206）

摘　　要：目的探讨肝移植对肝肺综合征（HPS）的疗效及影响其预后的危险因素。方法对2004年4月至2006年1月收治的26例合并HPS及30例未合并HPS的终末期肝病患者进行研究，探讨各组肝移植术后的生存率，并通过单因素及COX生存分析探索HPS影响肝移植预后的危险因素。结果HPS患者肝移植术后28d的生存率为76．9％（20／26），术后半年及1年的生存率为61．5％（16／26），未合并HPS的终末期肝病患者1年生存率为100％（P〈0．05）。单因素相关分析发现，^99Tc^m-大聚合白蛋白分流率、吸入空气的PaO2和术前氧分压／吸入气体氧含量（PaO2／FiO2）比值与肝移植术后围手术期及术后半年的预后相关（P〈0．05）。COX生存分析发现，^99Tc^m-大聚合白蛋白肺分流率（OR=1．182，P=0．001）及术后机械通气时间（OR=1．003，P=0．053）为影响HIS肝移植患者术后预后的独立危险因素。术前^99Tc^m-大聚合白蛋白肺分流率≥28．4％或吸空气PaO2≤56mmHg（1mmHg=0．133kPa），提示肝移植术后的预后较差，其敏感性分别为83．3％和85．O％，特异性分别为95．0％和83．3％。结论肝移植是HPS的有效治疗方法。^99Tc^m-大聚合白蛋白肺分流率及术后机械通气时间是影响HPS肝移植患者术后生存的独立危险因素。Objective To observe the effect of orthotopic liver transplantation （OLT） on hepatopulmonary syndrome （ HPS ） and investigate risk factors predicting the prognosis of OLT. Methods Twenty-six cases of HPS and 30 cases of non-HPS were analyzed treated from April 2004 to January 2006. Survival rates after OLT were compared and risk factors predicting the prognosis of OLT in HPS were researched by univariant and COX analysis. Results The 28 days survival rate in HPS after OLT was 76. 9% （20/26） ,half a year survival rate and one year survival rate were both 61.5% （16/26）. Whereas the one year survival rate of patients without HPS was 100% （P 〈 0. 05 ）. By univariant analysis, shunt of 99Tern-labeled macro-aggregated albumin in lungs, PaO2 and PaO2/FiO2 in room air before operation were relative to the prognosis of peri-operative period and half a year outcome after OLT in HPS（ P 〈 0. 05 ）. Shunt of ^99Tc^m-labeled macro-aggregated albumin in lungs （ OR = 1. 182, P = 0. 001 ）, and mechanical ventilation time（ OR = 1. 003, P = 0. 053 ） after OLT were independent risk factors predicting the prognosis of OLT in HPS by COX analysis. Shunt of ^99Tc^m-labeled macro-aggregated albumin in lungs ≥ 28.4% , or PaO2 ≤ 56 mm Hg（1 mm Hg =0. 133 kPa） before OLT predicted the poor outcome of OLT in HPS. The sensitivity were 83.3% and 85.0% respectively, and the specificity were 95.0% and 83.3% respectively. Conclusions OLT is an effective treatment for HPS. Shunt of ^99Tc^m-labeled macro-aggregated albumin in lungs before OLT and mechanical ventilation time after OLT were independent risk factors for the prognosis of OLT in HPS.

关 键 词：肝肺综合征 肝移植 预后 危险因素 围手术期 

分 类 号：R686[医药卫生—骨科学]