肝移植受者术前铁代谢情况对ICU住院时间的影响  

Effect of iron metabolism of preoperation on the length of intensive care unit stay in liver transplant recipients

作　　者：白媛媛[1] 李阳[2] 刘娟[1] 鞠鹏 Bai Yuanyuan;Li Yang;Liu Juan;Ju Peng(Department of Clinical Laboratory,Tianjin First Central Hospital,Tianjin 300192,China;Department of Transplant Surgery,Tianfin First Central Hospital,Tianjin 300192,China;Department of Clinical Laboratory,Tianfin Haibin People＇s Hospital,Tianjin 300280,China)

机构地区：[1]天津市第一中心医院检验科,300192 [2]天津市第一中心医院移植外科,300192 [3]天津海滨人民医院检验科,300280

出　　处：《中华危重病急救医学》2018年第8期804-806,共3页Chinese Critical Care Medicine

基　　金：天津市卫计委科技基金（2015KZ034）

摘　　要：目的 评价肝移植受者术前铁代谢情况对术后重症加强治疗病房（ICU）住院时间的影响.方法采用回顾性研究方法,选择2015年9月至2017年9月在天津市第一中心医院住院的120例成人肝移植受者.收集患者入院时基础资料、终末期肝病模型（MELD）评分;入院24 h内铁代谢指标、血常规、血生化、出凝血时间和C-反应蛋白（CRP）水平;术中临床指标,如手术时间、出血量、红细胞和新鲜冷冻血浆输入量、热缺血时间、冷缺血时间、尿量;术后ICU住院时间.按照术前铁缺乏标准将患者分为缺铁组（血清铁蛋白〈100μg/L,或者血清铁蛋白100～300μg/L、转铁蛋白饱和度〈0.20）和非缺铁组（血清铁蛋白〉300μg/L,或者血清铁蛋白100～300μg/L、转铁蛋白饱和度〉0.20）,比较两组患者铁代谢指标、入院基本资料和临床指标的差异;采用Pearson相关分析患者血清铁蛋白水平与ICU住院时间的相关性.结果与非缺铁组比较,缺铁组血清铁浓度和血清铁蛋白水平均明显降低〔血清铁浓度（μmol/L）：3.50±1.62比14.50±2.31,血清铁蛋白（μg/L）：67.00±31.54比315.00±36.73,均P〈0.01〕,术中红细胞、新鲜冰冻血浆输入量显著增多,ICU住院时间明显延长（d：6.5±2.4比3.3±0.5,P〈0.01）,而两组转铁蛋白饱和度、CRP等其他临床指标比较差异均无统计学意义.相关性分析显示,血清铁蛋白水平与ICU住院时间呈显著负相关（r=-0.768,P〈0.001）.结论肝移植受者术前缺铁会导致术中输血量增加,ICU住院时间延长. Objective To evaluate the effect of iron metabolism of preoperation on the length of intensive care unit （ICU） stay in liver transplant recipients.Methods A retrospective study was conducted. 120 adult liver transplant recipients admitted to Tianjin First Central Hospital from September 2015 to September 2017 were enrolled. The basic data, model of end-stage liver disease （MELD） evaluation system score at admission; iron metabolism index, routine blood test, blood biochemistry, coagulation time and C-reactive protein （CRP） level within 24 hours after admission; intraoperative clinical indicators such as operation time, operation bleeding volume, red blood cells and fresh frozen plasma input volume, hot ischemia time, cold ischemia time, urine volume; and the length of ICU stay were collected. All patients were divided into iron deficiency group （ID group; serum ferritin 〈 100μg/L, or serum ferritin 100-300μg/L and transferrin saturation 〈 0.20） and non-iron deficiency group （non-ID group; serum ferritin 〉 300μg/L, or serum ferritin 100-300μg/L and transferrin saturation 〉 0.20） according iron deficiency standard. The indexes of iron metabolism, basic data and clinical indicators of two groups were compared. The correlation between serum ferritin level and the length of ICU stay was analyzed by Pearson correlation.Results Compared with non-ID group, the levels of serum iron concentration and serum ferritin were significantly decreased in ID group [serum iron concentration （μmol/L）： 3.50±1.62 vs. 14.50±2.31, serum ferritin （μg/L）： 67.00±31.54 vs. 315.00±36.73, bothP 〈 0.01], infusion volume of intraoperative red blood cells and fresh frozen plasma were significantly increased, and the length of ICU stay was significantly prolonged （days： 6.5±2.4 vs. 3.3±0.5,P 〈 0.01）. There was no significant difference in transferrin saturation, CRP and other clinical indicators between the two groups. Correlation analysis showed that serum ferritin level was nega

关 键 词：重症加强治疗病房 肝移植 铁蛋白 转铁蛋白饱和度 住院时间 

分 类 号：R657.3[医药卫生—外科学]