肝移植术后早期肺部并发症的危险因素分析及预防  

Analysis and prophylaxis of the risk factors in early pulmonary complication after transplantation of liver

作　　者：田玉伟[1] 周杰[1] 王宇[1] 林艺雄[1] 谭永法[1] 郑志鹏[1] 唐彬[1] 

机构地区：[1]南方医科大学附属南方医院肝胆外科,广东广州510515

出　　处：《新乡医学院学报》2011年第2期174-176,共3页Journal of Xinxiang Medical University

基　　金：广东省科技计划项目(编号:2007B031514004)

摘　　要：目的探讨肝移植术后早期肺部并发症的危险因素。方法回顾性分析154例肝移植患者的临床资料。选取围手术期22个独立变量进行单因素分析及Logistic回归分析,筛选出与肝移植术后早期肺部并发症相关的危险因素。结果肝移植术后早期共98例患者发生肺部并发症,发生率为63.6%。单因素分析并发症组与对照组的各项参数,结果发现术前肝功能Child-Pugh评级为C级、术中出血量>2 L、输液总量>10 L、术后前3 d补液至少1 d液体平衡≤-500 mL、低蛋白血症、输注血制品>4 L、重症监护室(ICU)留观时间≥5 d及术后前3 d补液至少2 d液体平衡≤-500 mL共8项有统计学意义。将以上有统计学意义的8个因素作为自变量,术后肺部并发症作为应变量进行Logistic回归分析发现,术前低蛋白血症、术中输注血制品>4 L、ICU留观时间≥5 d及术后前3 d至少有2 d的液体平衡≤-500 mL具有统计学意义。结论低蛋白血症、术中输注血制品>4 L及ICU留观时间≥5 d是术后发生肺部并发症的危险因素。肝移植术前改善低蛋白血症,术中控制输注血液制品量,减少ICU留观时间及术后尽早实现液体出人量的负平衡可减少术后肺部并发症的发生率。Objective To probe the risk factors in early pulmonary complication after transplantation of liver.Methods Clinical data of 154 patients of liver transplantation were analysed retrospectively.Twenty-two independent variable of peroperative period were selected for univariate analysis and Logistic regression analysis.The risk factors relating with early pulmonary complication were screened.Results The early pulmonary complication after transplantation of liver occurred in 98 patients（63.6%）.Each variable of complication group and control group was analyzed with monofactorial analysis.The results showed that Child-Pugh level was C,perioperative bleeding 〉2 L,transfusion volume dose 〉10 L,during the first three days after operation,fluid balance ≤-500 mL was kept no less than one day,hypoproteinemia and infusion blood products 〉4 L,intensive care unit（ICU） observing time 〉5 days and fluid balance≤-500 mL was kept no less than two days were statistical significances.The above eight factor as independent variables,and the pulmonary complication after liver transplantation as dependent variables for Logistic multivariate regression analysis.The results showed that pre-operative hypoproteinemia,blood products of transfusion 〉4 L,ICU observing time 〉5 days and fluid balance ≤-500 mL was kept no less than two days had statistical significance.Conclusion The hypoproteinemia,blood products of transfusion 〉 4 L and ICU observing time 〉5 days were risk factors of pulmonary complication after transplantation of liver.Improving pre-operative hypoproteinemia,controlling the amount of blood products-transfusion,reducing the time of observation in ICU and implementing the negative balance of liquid intake and output volume as soon as possible can reduce the incidence of pulmonary complications. 更多

关 键 词：肝脏移植 肺部并发症 危险因素 

分 类 号：R657.3[医药卫生—外科学]