小儿亲属间活体肝移植术后急性肺损伤的危险因素  

Risk factors of acute lung injury after pediatric living related liver transplantation

作　　者：陆秉玮[1] 陈湧鸣[1] 夏苏云[1] 怀晓蓉[1] 周姝婧[1] 黄丹[1] 张建军[2] 夏强[2] 王祥瑞[1] 

机构地区：[1]上海交通大学医学院附属仁济医院麻醉科,上海200127 [2]上海交通大学医学院附属仁济医院肝脏外科,上海200127

出　　处：《上海医学》2013年第8期662-665,共4页Shanghai Medical Journal

基　　金：上海交通大学医学院麻醉学重点学科基金资助项目(2008)

摘　　要：目的回顾性分析小儿亲属间活体肝移植术(LRLT)后急性肺损伤(ALI)的危险因素。方法 2006年10月—2012年4月在上海交通大学医学院附属仁济医院行LRLT的患儿74例,术后发生ALI(ALI组)40例(54.1%),未发生ALI(非ALI组)34例(45.9%)。将单因素分析筛选出的危险因素进行二元Logistic分析。结果单因素分析显示,ALI组年龄≤12个月、术前1个月前有呼吸系统感染史、机械通气时间>24h、再次开腹手术的构成比,术中静脉输注白蛋白总量、术中单位时间每公斤体重出入量(简称出入量)和出院前总胆红素(TBil)水平均显著高于非ALI组(P值均<0.05),术前血钾、血红蛋白(Hb)水平均显著低于非ALI组(P值均<0.01)。二元Logistic回归分析显示,年龄≤12个月(β=-1.39,OR=0.25,95%CI为0.09～0.69)、术前1个月前有呼吸系统感染史(β=1.90,OR=6.66,95%CI为1.89～23.50)、术前Hb水平<90g/L(中、重度贫血,β=1.22,OR=3.40,95%CI为1.27～9.08),术前血钾水平<3.5mmol/L(低钾血症,β=1.45,OR=4.26,95%CI为1.51～12.03)、静脉输注白蛋白总量(β=0.05,OR=1.50,95%CI为1.01～2.11)、术中出入量(β=4.40,OR=81.4,95%CI为1.31～5 017.50)、机械通气时间>24h(β=1.28,OR=3.60,95%CI为1.36～9.51)、再次行开腹手术(β=1.67,OR=5.33,95%CI为1.10～26.40)均是ALI发生的独立危险因素(P值分别<0.05、0.01)。结论年龄≤12个月,术前1个月前有呼吸系统感染史,术前中、重度贫血,术前低钾血症,术中出入量和静脉注射白蛋白总量,术后机械通气时间>24h,以及再次开腹手术是LRLT术后ALI发生的危险因素。Objective To analyze risk factors of acute lung injury （ALl） after pediatric living related liver transplantation （LRLT） by a retrospective survey. Methods Seventy-four children undergoing LRLT from October 2006 to April 2012 were enrolled in the study. According to the presence of posttransplantation ALl, the patients were divided into ALl group （n =40） and non-ALl group （n = 34）. Several statistically significant risk factors were screened out with univariate analysis. Then independent risk factors were determined with binary logistic regression analysis. Results Univariate analysis showed that the constituent ratios of the patients （aged - 12 months, with respiratory infection one month or more before LRLT, mechanical ventilation time - 24 h, or reoperation）, intraoperative albumin consumption, per kilogram per minute intake and output volume, preoperative and total bilirubin （TBil） before discharge in the ALl group were significantly higher than those in the non-ALl group （all P〈0.05）, while serum potassium and preoperative hemoglobin （Hb） in the ALl group were significantly lower than those in the non-ALl group （all P〈0.01）. Logistic regression revealed that age （4 12 months, β = - 1.39, OR=0.25, 95%C1： 0.09-0.69）, respiratory infection one month or more before LRLT （β= 1.90, OR=6.66, 95 % CI ： 1.89 - 23.50）, moderate or severe anemia （Hb〈90 g/L） before LRLT （β=1.22, OR = 3.40, 95 % CI ： 1.27-9.08）, preoperative hypokalemia （〈3.5 mmol/L,/3= 1.45, 0R=4.26, 95%C1： 1. 51- 12.03）,intraoperative albumin consumption （β = 0.05, OR = 1.50, 95 % CI ： 1.01 - 2.11 ）, per kilogram per minute intake and output volume （β = 4.40, OR = 81.4, 95 % Cl： 1.31 - 5017.50）, mechanical ventilation time （24 h, β = 1.28, OR = 3.60, 95 % CI ： 1.36 - 9.51 ）, and reoperation （/3 = 1.67, OR = 5.33, 95 % CI ： 1.10 - 26.40） were independent risk factors of ALl. Conclusion Postoperative ALT is closely related to patients who aged~ 12 months

关 键 词：小儿亲属间活体肝移植 急性肺损伤 危险因素 围术期 

分 类 号：R726.1[医药卫生—儿科]