肝移植受体术前血钠浓度对早期预后的影响  

Effect of preoperative serum sodium concentration on the early prognosis of liver transplantation recipients

作　　者：王冬雨[1] 陈亚斌 马言 陈天然[1] 李冉冉[1] 卫凌华 王盼梁 郭文治[1] Wang Dongyu;Chen Yabin;Ma Yan;Chen Tianran;Li Ranran;Wei Linghua;Wang Panliang;Guo Wenzhi(First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, Chin)

机构地区：[1]郑州大学第一附属医院,450052

出　　处：《国际外科学杂志》2018年第6期378-382,共5页International Journal of Surgery

基　　金：国家自然科学基金（81671958）

摘　　要：目的分析肝移植受体术前血钠浓度与患者术前健康状况的关系及对早期移植效果的影响。方法收集2016年1月．2017年9月在郑州大学第一附属医院行肝移植手术的281例患者的临床资料，根据术前血钠浓度分为低血钠组（〈130mmol／L）18例、正常血钠组（130～145mmol／L）232例、高血钠组（〉145mmol／L）31例，分析各组在术前MELD评分、Child—Pugh评分，术后患者生存率及肝功能不良发病率等方面是否有差异。计量资料用均数±标准差（面±s）表示，多组间比较采用方差分析，组间两两比较采用LSD-t检验，计数资料用百分率（％）表示，组间比较采用，检验。结果低血钠组患者术前MELD评分为（19．27±7．35）分、Child—Pugh评分为（10．39±2．28）分、血肌酐浓度为（95．89±49．40）μmol／L，正常血钠组术前MELD评分为（12．17±8．79）分、Child—Pugh评分为（8．50±2．68）分和血肌酐浓度为（66．07±24．13）μmol／L相比，差异均具有统计学意义（P〈0．05）；3组患者在术后ICU住院时间、术后总住院时间上差异无统计学意义（P〉0．05），在术后30d和90d生存率及肝功能不良发病率上差异均无统计学意义（P〉0．05）。结论低钠血症是肝移植受体术前健康状况较差的指标；肝移植受体术前血钠浓度对早期预后没有明显影响。Objective To analyze the relationship between preoperative serum sodium concentration and preoperative status of liver transplantation recipients and it＇ s effect on early prognosis. Methods Retrospectively collected the clinical data of 281 patients underwent liver transplantation in First Affiliated Hospital of Zhengzhou University from January 2016 to September 2017. According to the preoperative serum sodium concentration, they were divided into hyponatremia group （ 〈 130 mmol/L） 18 patients, normonatremia group （ 130-145 mmol/L） 232 patients and hypernatremia group （ 〉 145 mmol/L） 31 patients. The SPSS 21.0 statistical software was used to analyze the difference of preoperative MELD score, Child- Pugh score, postoperative survival rate and the incidence of graft dysfunction among three groups. Multivariate comparisons of measurement data were performed using analysis of variance. Pairwise comparisons between groups were performed using the LSD-t test. Chi-square tests were used to compare the count data sets. Results The preoperative MELD score was （19.27 ± 7.35 ） scores, Child-Pugh score was （ 10.39± 2.28 ） scores, serum creatinine concentration was （95.89 ± 49.40） μmol/L in hyponatremia group, the preoperative MELD score was （ 12.17 ± 8.79 ） scores （ P = 0.001 ） , Child- Pugh score was （ 8.50 ± 2.68 ） scores （ P = 0.004） and serum creatinine was （66.07 ±- 24.13 ） μmol/L （ P 〈 0.05 ） in normonatremia group, the difference between two groups were statistically significant. There were no significant difference in the length of postoperative ICU stay and postoperative hospital stay among the three groups, there were no significant difference between the 30th and 90th postoperative survival rates and the incidence of graft dysfunction. Conclusions Hyponatremia is an indicator of poor preoperative status in liver transplantation recipients. Preoperative serum sodium concentration has no significant effect on early prognosis of liver transplantation.

关 键 词：肝移植 预后 受体 血钠浓度 生存率 

分 类 号：R657.3[医药卫生—外科学]