双重血浆分子吸附系统模式人工肝治疗中低血压发生的影响因素分析  

Influencing factors for hypotension in patients undergoing double plasma molecular adsorption system artificial liver support therapy

作　　者：胡东燕 王红 李文渊[1] 宁玲 韩华 沈强 江守伟 李磊[1] HU Dongyan;WANG Hong;LI Wenyuan;NING Ling;HAN Hua;SHEN Qiang;JIANG Shouwei;LI Lei(Department of Infectious Diseases,The First Affiliated Hospital of University of Science and Technology of China,Hefei 230001,China)

机构地区：[1]中国科学技术大学附属第一医院感染病科,合肥230001

出　　处：《临床肝胆病杂志》2022年第9期2078-2083,共6页Journal of Clinical Hepatology

基　　金：安徽省自然科学基金资助项目(1208085QH147);北京肝胆相照公益基金会人工肝专项基金课题(RGGJJ-2021-002)。

摘　　要：目的探讨双重血浆分子吸附系统(DPMAS)模式人工肝治疗过程中患者发生低血压(IOH)的相关危险因素。方法收集2017年10月1日—2020年12月31日中国科学技术大学附属第一医院肝病中心行DPMAS人工肝治疗的181例患者(共计670例次)的临床资料,根据人工肝治疗过程中是否发生低血压,分为IOH组(70例)和非IOH组(111例)。比较两组患者各项临床指标,并分析其与IOH发生的相关性以及12周、24周预后。符合正态分布的计量资料两组间比较采用独立样本t检验,非正态分布的计量资料两组间比较采用Mann-Whitney U检验。计数资料组间比较采用χ^(2)检验。IOH相关危险因素采用单因素及多因素Logistic回归分析。Kaplan-Meier法绘制受试者工作特征曲线(ROC曲线),独立危险因素的ROC曲线下面积(AUC)比较采用Z检验。结果单因素Logistic回归分析显示,女性、年龄≥50岁、正常及低BMI(≤24 kg/m^(2))者发生IOH的风险更高(P值均<0.05);多因素分析显示,正常及低BMI(OR=3.290,95%CI:1.523~7.108,P=0.002)、女性(OR=5.146,95%CI:2.316~11.432,P<0.001)是DPMAS人工肝患者出现IOH的独立危险因素。女性+BMI≤24 kg/m^(2)联合进行ROC曲线分析,其预测IOH的AUC为0.639(P=0.002)。IOH组与非IOH组12周(76.53%vs 55.77%,χ^(2)=6.887,P=0.009)和24周(74.49%vs 50.00%,χ^(2)=9.080,P=0.003)的生存率比较差异均有统计学意义。结论女性、正常或低BMI值患者行DPMAS模式人工肝治疗中发生低血压风险大;发生IOH者24周生存预后差。Objective To investigate the risk factors for intraoperative hypotension(IOH)in patients undergoing double plasma molecular adsorption system(DPMAS)artificial liver support therapy.Methods Clinical data were collected from 181 patients(670 cases in total)who underwent DPMAS artificial liver support therapy in Liver Disease Center of The First Affiliated Hospital of University of Science and Technology of China from October 1,2017 to December 31,2020,and according to the presence or absence of IOH during DPMAS therapy,they were divided into IOH group with 70 patients and non-IOH group with 111 patients.Clinical indicators were compared between the two groups and their association with IOH was analyzed;prognosis was analyzed at 12 and 24 weeks.The independent samples t-test was used for comparison of normally distributed continuous data between groups,and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between groups;the chi-square test was used for comparison of categorical data between groups.Univariate and multivariate Logistic regression analyses were used to investigate the risk factors for IOH.The Kaplan-Meier method was used to plot receiver operating characteristic(ROC)curves,and the Z test was used for comparison of the area under the ROC curve(AUC)of independent risk factors.Results The univariate Logistic regression analysis showed that female individuals,individuals aged≥50 years,and individuals with normal or low body mass index(BMI)tended to have a higher risk of IOH(all P<0.05),and the multivariate analysis showed that normal or low BMI(odds ratio[OR]=3.290,95%confidence interval[CI]:1.523-7.108,P=0.002)and female sex(OR=5.146,95%CI:2.316-11.432,P<0.001)were independent risk factor for IOH in patients undergoing DPMAS artificial liver support therapy.The ROC curve analysis of female sex+BMI≤24 kg/m^(2) showed that it had an AUC of 0.639 in predicting IOH(P=0.002).The patients experiencing IOH had a 12-week survival rate of 55.77%(29/52)and a 24-week sur

关 键 词：肝 人工 低血压 预后 

分 类 号：R544.2[医药卫生—心血管疾病]