术前血肌酐和尿素氮正常患者肝移植早期急性肾损伤的发生与生存分析  

Occurrence and Survival Analysis of Acute Kidney Injury in Patients with Normal BUN and SCr in the Early Post-liver Transplantation Period

作　　者：李晓芸[1] 罗刚健[1] 黎尚荣[1] 关健强[1] 刘德昭[1] 黑子清[1] 

机构地区：[1]中山大学附属第三医院麻醉科,广东广州510630

出　　处：《中山大学学报（医学科学版）》2013年第3期397-401,共5页Journal of Sun Yat-Sen University:Medical Sciences

基　　金：国家自然科学基金(81170449);广东省自然科学基金重点项目(S2011020002780)

摘　　要：【目的】分析术前血肌酐、尿素氮正常患者的肝移植早期急性肾损伤(AKI)的发生及生存状况。【方法】82例术前血肌酐、尿素氮正常患者在我院移植中心接受下腔静脉全阻断改良背驮式肝移植术。术后3 d(术后早期)将根据AKI网络工作组有关急性肾损伤诊断标准评估AKI发生和分期,并根据急性肾损伤情况将病人分为两组:急性肾损伤组(A组),非急性肾损伤组(C组),术后追踪并记录2组患者术后30 d、术后1、2和3年生存率。【结果】82例术前血肌酐、尿素氮正常肝病患者,除去2例再次移植者,共80例,出现急性肾损伤38例(A组),发生率为47.5%;未发生急性肾损伤42例(C组)。A组MELD大于18分和循环不稳定发生率高于C组(P<0.05);A组术后呼吸机时间和ICU停留时间高于C组(P<0.05);A组术后30 d、术后1年生存率和术后2年生存率低于C组(86.8%vs 100%,78.9%vs 95.2%s及71.1%vs 90.5%;P<0.05),术后3年生存率数值虽低但无统计差异(63.2%vs 81%,P>0.05)。【结论】术前血肌酐、尿素氮正常的患者肝移植急性肾损伤发生率仍然较高,并影响术后短期和长期生存。[Objective] To analyze the occurrence and survival situation of acute kidney injury in the patients with normal BUN and SCr in the early post-liver transplantation period.[Methods] A total of 82 patients with preoperative normal BUN and SCr in our hospital liver transplant center who underwent inferior vena cava blockade modified piggyback liver transplantation.Three days after surgery （early post-liver transplantation period） with assessment according to the AKI Network Working Group on diagnostic criteria of acute kidney injury （AKI） occurrence and stage,patients were divided into two groups according to the situation of acute kidney injury：acute kidney injury group （A group） and control group （C group）,postoperative 30 days,postoperative 1-year,2-year,and 3-year after surgery survival of these patients in the two groups were followed and recorded respectively.[Results] 82 end stage liver diseases patients with preoperative normal BUN and SCr,removed the two cases of retransplantation,a total 80 patients of which 38 patients developed acute kidney injury （A group）,the incidence was 47.5%; the others 42 patients were control subjects （C group）,Compared with C group,the cases of MELD score more than 18 points and circulatory instability were more in group A （P 〈 0.05）.The time of postoperative ventilator and ICU stay were longer in group A （P 〈 0.05）.Postoperative 30 days,1-year,2-year survival rates in group A were lower than that in group C （86.8% vs 100%,78.9% vs 95.2% and 71.1% vs 90.5%） （P 〈 0.05）.Postoperative 3-year survival rate was still lower in group A,but there is no statistical difference （63.2% vs 81%） （P 〉 0.05）.[Conclusions] The incidence of acute renal injury after liver transplant is still high in patients with preoperative normal BUN and SCr,which affects postoperative short-term and long-term survival.

关 键 词：急性肾损伤 肝移植 生存率 

分 类 号：R617[医药卫生—外科学]