肝肾综合征患者肝移植过程中的肾功能维护  

Renoprotective treatment for perioperative hepatorenal syndrome in liver transplantation

作　　者：江涛 王轩 陆雷 张斌 李增才 张冬华 刘现忠 张荣生 

机构地区：[1]解放军第八一医院南京军区肝移植中心,江苏省南京市210002

出　　处：《中国组织工程研究与临床康复》2010年第53期9995-9999,共5页Journal of Clinical Rehabilitative Tissue Engineering Research

摘　　要：背景:肝移植围手术期均会出现不同程度的肾功能损害,尤其对于肝肾综合征患者会直接影响其生存。目的:观察肝肾综合征患者在肝移植围手术期采用系统的肾功能维护方案对促进肾功能恢复及改善术后生存率的影响。方法:纳入171例行同种异体原位移植患者,对54例肝肾综合征患者中后期34例患者采用系统的肾功能维护方案,观察手术后血肌酐值的变化趋势以及术后急性肾衰发生率、感染率、死亡率、ICU治疗时间、总住院时间等各项指标,并与前期未采用肾功能维护方案的20例患者(非维护组),及移植前肾功能正常的117例(对照组)进行对比。结果与结论:采用肾功能维护方案的患者术后血肌酐峰值低,下降快,与非维护组比较差异显著;非维护组急性肾功能衰竭的发生率高于维护组(χ2=6.523,P=0.011)。肾功能维护组的感染发生率和围手术期死亡率与术前肾功能正常的对照组比较差异无显著性意义(P>0.05);而与非维护组比较明显改善,非维护组死亡率高于维护组(χ2=6.018,P=0.014),感染发生率、总并发症发生率、ICU治疗时间和总住院时间等方面差异非常显著(P<0.01)。提示对于行肝移植手术的肝肾综合征患者采用包括个体化免疫抑制剂和持续性肾脏替代治疗等措施相结合的系统的肾功能维护方案有利于术后肾功能的恢复,降低并发症发生率和改善预后。BACKGROUND：Renal impairment of varying degree is common at perioperative period of liver transplantation and especially has immediate impact on survival of hepatorenal syndrome（HRS） patients.OBJECTIVE：To investigate the role of perioperative comprehensive renoprotective treatment in improving the renal function and survival rate of HRS patients after liver transplantation.METHODS：All 54 patients with preoperative HRS were divided into two groups：The latter 34 patients received comprehensive renoprotective treatment（renoprotective group） and the former 20 patients did not（non-renoprotective group）.Meanwhile,the serum level of creatinine（Cr） was measured and the incidence of postoperative acute renal failure,infection,morbidity,mortality and the ICU stay were determined and compared with the other 117 patients without preoperative HRS（control group）.RESULTS AND CONCLUSION：The serum level of Cr-max was significantly lower and dropped faster in the renoprotective group as comparing with non-renoprotective group,the incidence of postoperative acute renal failure improved in the same way（χ2=6.523,P=0.011）.The incidence of infection and perioperative mortality of renoprotective group were the same as that of control group（P 0.05）.Compared with the non-renoprotective group,the patients received comprehensive renoprotective treatment had significantly lower mortality（χ2=6.018,P=0.014）,ICU stay and infection rate（P 0.01）.Perioperative comprehensive renoprotective treatment can effectively improve renal function,lower morbidity and promote survival rate in patients with HRS underwent liver transplantation.

关 键 词：肝肾综合征 肝移植 雷帕霉素 赛尼哌 持续肾脏替代治疗 

分 类 号：R617[医药卫生—外科学]