APACHEII模式联合MELD评分在预测活体肝移植围手术期预后中的作用  

The contribution of perioperative prognosis evaluation of patients underwent living donor liver transplantation with Acute Physiology and Chronic Health Evaluation II models and MELD

作　　者：陈瑞[1] 申川[1] 万亮[1] 严佶祺[1] 周光文[1] 彭承宏[1] 李宏为[1] 

机构地区：[1]上海交通大学医学院附属瑞金医院外科上海消化外科研究所,上海200025

出　　处：《中国实用外科杂志》2011年第1期83-85,88,共4页Chinese Journal of Practical Surgery

摘　　要：目的探讨APACHE(急性生理学和慢性健康评分)II模式联合MELD(终末期肝病模型)评分如何准确地评估活体肝移植围手术期预后。方法总结2006年6月至2009年5月在上海交通大学附属瑞金医院行活体肝移植术38例病人临床资料。结果围手术期存活组与死亡组病人的APACHE II分值分别为13.03±3.47和23.67±3.27;死亡风险度分别为(7.05±3.70)%和(25.07±9.34)%。两组病人的APACHE II分值、死亡风险度差异具统计学意义(P<0.001)。排除外科因素后APACHE II模式对预后的评估具有更好的准确性。MELD>25分与MELD<25分的病人预期病死率分别为(7.10±3.84)%和(15.11±11.93)%,差异具统计学意义(P<0.05)。APACHE II评分和MELD评分的接受者操作特征曲线(ROC)界值分别为20分和25分。结论应用APACHE模式对活体肝移植进行评估时应注意避免外科因素干扰;校正后APACHE II模式预测准确性更佳;APACHE II>20分或MELD>25分的病人预期病死率则显著增高。Objective To study the methods of evaluation of living donor liver transplantation（LDLT） perioperative prognosis by APACHE II models associated with MELD accurately. Methods The clinical and laboratory data of 38 patients receiving LDLT in our hospital from June 2006 to May 2009 were retrospectively analyzed. Results Mean （standard deviation [SD]） APACHE II score of survivors and non-survivors were 13.03 （3.47） and 23.67（3.27） respectively.Mean（SD） risk of death were 7.05% （3.70%） and 25.07% （9.34%） respectively.There was a magnificent difference in APACHE II score and risk of death between two groups（P 〈 0.001）. APCHE models have more accuracy of evaluation after excluding the surgical interference. Mean（SD） predicted hospital mortality of patients with MELD 〉 25 and MELD〈25 were 7.10% （3.84%） and 15.11% （11.93%） respectively and have statistical discrepancy（P〈0.05）. APACHE II score and MELD in the ROC cutoff value was 20 and 25 respectively. Conclusions Pay attention to preventing the surgical interference when prognosis evaluation of patients underwent LDLT with APACHE models.The modified APACHE II model can provide an closely accurate prognosis evaluation of patients performed LDLT.The predicted hospital mortality of the patients with APACHE II〉20 or MELD〉25 increase obviously.

关 键 词：活体肝移植 急性生理学与慢性健康状况评分Ⅱ 终末期肝病模型 

分 类 号：R6[医药卫生—外科学]