尸体肾移植受者术后围术期腹泻的影响因素分析  

Influencing factors for perioperative diarrhea in recipients after deceased-donor kidney transplant

作　　者：袁智辉 杨麒臻 贾磊 晁晟 徐媛 潘光辉 牛玉林 YUAN Zhihui;YANG Qizhen;JIA Lei;CHAO Sheng;XU Yuan;PAN Guanghui;NIU Yulin(Department of Transplantation Surgery,Affiliated Hospital of Guizhou Medical University,Guiyang,Guizhou Province,550004,China)

机构地区：[1]贵州医科大学附属医院器官移植科,贵阳550004

出　　处：《陆军军医大学学报》2023年第14期1556-1561,共6页Journal of Army Medical University

基　　金：黔科合基础-ZK[2023]一般380。

摘　　要：目的探讨导致尸体肾移植受者术后围术期腹泻的相关因素。方法采用病例-对照研究设计方案,收集2017年7月至2021年12月贵州医科大学附属医院器官移植科545例尸体肾移植受者围术期的临床资料,分为腹泻组(207例)和非腹泻组(338例),统计对比两组受者年龄、性别、体质指数(body mass index,BMI)、手术时间、透析方式、是否患有2型糖尿病、免疫诱导方案、霉酚酸(mycophenolic acid,MPA)种类、预防感染方案、术前灌肠、移植肾功能延迟恢复(delayed graft function,DGF)发生情况等。采用多因素Logistic逐步回归分析与尸体肾移植术后围术期腹泻相关的因素。结果尸体肾移植术后围术期腹泻发生率为37.98%(207/545),腹泻组受者腹泻发生时间为移植后(5.90±6.94)d,其中腹泻发生在3 d内的患者占71.98%(149/207)。单因素分析结果显示:年龄、性别、BMI、2型糖尿病、免疫诱导方案、抗生素预防感染方案、术前灌肠、术后发生DGF差异均有统计学意义。多因素Logistic逐步回归分析结果显示:超重患者(OR=1.074,95%CI:1.011~1.141)、性别为男性(OR=1.596,95%CI:1.032~2.470)、术后发生DGF(OR=3.001,95%CI:1.712~5.260)、哌拉西林钠他唑巴坦钠的预防感染方案(OR=3.119,95%CI:1.918~5.074)是尸体肾移植受者发生围术期腹泻的独立危险因素。结论超重、男性、移植后发生DGF、使用哌拉西林钠他唑巴坦钠作为预防感染方案可能是尸体肾移植受者在围术期发生腹泻的风险因素。Objective To explore the related factors of perioperative diarrhea in cadaveric renal transplant recipients.Methods A case-control trial was conducted on 545 recipients receiving cadaveric renal transplantation in the Affiliated Hospital of Guizhou Medical University from July 2017 to December 2021.Their clinical data during perioperative period were collected,and then all recipients were divided into the diarrhea group(n=207)and non-diarrhea group(n=338).Their age,gender,body mass index(BMI),duration of operation,dialysis types,type 2 diabetes or not,immune induction regimen,mycophenolic acid(MPA)types,infection prevention regimen,preoperative enema,and occurrence of delayed graft function(DGF)were observed and recorded.Multivariate stepwise logistic regression analysis was used to analyze the factors related to the perioperative diarrhea in these recipients.Results The incidence of perioperative diarrhea was 37.98%(207/545).The occurrence time of diarrhea was in 5.90±6.94 d after transplantation,and 71.98%(149/207)of diarrheal patients occurred within 3 d.Univariate analysis showed that significant differences were observed in age,gender,BMI,type 2 diabetes,immune induction regimen,antibiotic prevention regimen,preoperative enema,and post-operative DGF occurrence between the diarrhea and non-diarrhea groups.Multivariate stepwise logistic regression analysis indicated that overweight(OR=1.074,95%CI:1.011~1.141),male(OR=1.596,95%CI:1.032~2.470),post-operative DGF(OR=3.001,95%CI:1.712~5.260)and use of piperacillin after transplantation(OR=3.119,95%CI:1.918~5.074)were independent risk factors for perioperative diarrhea in cadaveric kidney transplant recipients.Conclusion Overweight,male,DGF and piperacillin use after transplantation may be the risk factors of perioperative diarrhea in cadaveric transplant recipients.

关 键 词：肾移植 腹泻 围术期 移植肾功能延迟恢复 哌拉西林 

分 类 号：R442.2[医药卫生—诊断学] R617[医药卫生—临床医学] R692