经下腔静脉逆行灌注对肝移植术后早期肾功能的影响  

Effect of retrograde perfusion via the inferior vena cava on renal function in the early stage after liver transplantation

作　　者：连锦锋 江艺[2] 胡还章[2] 蔡秋程[2] 

机构地区：[1]福建医科大学福总临床医学院,福州350025 [2]福州总医院肝胆外科,福州350025

出　　处：《临床肝胆病杂志》2017年第12期2384-2388,共5页Journal of Clinical Hepatology

摘　　要：目的探讨经下腔静脉逆行灌注对肝移植术后早期肾功能的影响。方法回顾性分析福州总医院2000年1月-2012年12月行肝移植患者(术前血清肌酐和尿素氮均正常)共103例。依据术中手术方式的不同分为经典原位肝移植组(A组)26例和经下腔静脉逆灌注肝移植组(B组)77例。比较分析2组患者的术前资料包括年龄、性别、原发病(肝癌/肝硬化)、肝功能MELD评分、术中下腔静脉阻断时间、术中输液总量和输血制品总量,以及术后第1~7、14、28天尿量、血肌酐水平和血尿素氮水平。计量资料组间比较采用独立样本t检验,计数资料组间比较采用χ2检验。结果 B组的下腔静脉阻断时间、术中输液总量和术中输血制品总量均明显低于A组,且差异均有统计学意义(t值分别为9.945、3.127、5.852,P值均<0.05)。2组患者术后急性肾衰竭的发生率差异无统计学意义(χ2=1.920,P>0.05)。A组患者术后第1、2天的尿量明显高于B组且差异有统计学意义(t值分别为3.613、2.929,P值均<0.05);术后第2~7、14、28天B组患者的血清肌酐值明显低于A组(t值分别为2.779、2.009、2.126、2.602、1.998、2.026、2.609、3.870,P值均<0.05);术后第1~7、14、28天B组患者的血清尿素氮明显低于A组(t值分别为5.895、3.212、1.830、2.348、3.030、3.549、2.287、2.996、2.775,P值均<0.05)。结论经下腔静脉逆行灌注肝脏移植对肝移植术后的肾功能影响更小,其更有利于术后的肾功能改善及恢复。Objective To investigate the effect of retrograde perfusion via the inferior vena cava on renal function in the early stage after liver transplantation. Methods A retrospective analysis was performed for the clinical data of 103 patients with normal serum creatinine and blood urea nitrogen before surgery who underwent liver transplantation in Fuzhou General Hospital from January 2000 to December 2012. According to the surgical approach,these patients were divided into groups A（ orthotopic liver transplantation,26 patients） and B（ retrograde perfusion via the inferior vena cava,77 patients）. The two groups were compared in terms of preoperative data [age,sex,primary diseases（ liver cancer/liver cirrhosis）,Model for End-Stage Liver Disease（ MELD） score],time of inferior vena cava occlusion during surgery,intraoperative infusion volume and total volume of blood products,and urine volume,serum creatinine,and blood urea nitrogen at 1-7,14,and 28 days after surgery. The independent samples t-test was used for comparison of continuous data between groups,and the chi-square test was used for comparison of categorical data between groups. Results Compared with group A,group B had a significantly shorter time of inferior vena cava occlusion and significantly lower intraoperative infusion volume and total volume of blood products（ t = 9. 945,3. 127,and 5. 852,all P〈0.05）. There was no significant difference in the incidence rate of acute renal failure after surgery between the two groups（ χ^2= 1. 920,P〉0.05）. At 1-2 days after surgery,group A had a significantly higher urine volume than group B（ t = 3. 613 and 2. 929,both P〈0.05）; at 2-7,14,and 28 days after surgery,group B had significantly lower serum creatinine than group A（ t =2. 779,2. 009,2. 126,2. 602,1. 998,2. 026,2. 609,and 3. 870,all P〈0.05）; at 1-7,14,and 28 days after surgery,group B had significantly lower blood urea nitrogen than group A（ t = 5. 895,3. 212,1. 830,2. 348,3. 030,3. 549,2. 287,2. 996,and 2. 775,all P〈0

关 键 词：肝移植 再灌注 肾疾病 

分 类 号：R657.3[医药卫生—外科学]