冷缺血时间对肝移植术后早期移植物功能的影响及其相关危险因素分析  

he effect of cold ischemia time on early graft function after liver transplantation and its related risk factors analysis

作　　者：高倩 杨龙 边冬梅 Gao Qian;YANG Long;BIAN Dongmei(Surgical Operation Room,The First Affliated Hospital of PLA Air Force Medical University,Xian70032,China;Department of Hepatobiliary Surgery,The First Afiliated Hospital of PLA Air Force Medical University,Xi an 710032,China)

机构地区：[1]中国人民解放军空军军医大学第一附属医院外科手术室,西安710032 [2]中国人民解放军空军军医大学第一附属医院肝胆外科,西安71003

出　　处：《肝胆外科杂志》2025年第1期18-23,共6页Journal of Hepatobiliary Surgery

基　　金：陕西省重点研发计划项目(2023-YBSF-226)。

摘　　要：目的探讨冷缺血时间(CIT)对肝移植术后早期移植物功能的影响,并分析术后早期移植物功能障碍(EAD)的相关危险因素。方法去选取2019年1月至2024年6月于空军军医大学第一附属医院移植中心完成肝移植术受者387例,根据供肝CIT将受者分为短CIT组(CIT≤6h,162例)、中CIT组(6h<CIT≤10h,146例)、长CIT组(CIT>10h,79例),对比3组术后1d、术后7d、术后14d的肝功能指标。同时根据肝移植术后EAD情况将所有受体划分为EAD组(n=62)与非EAD组(n=325),对比两组受体术前一般临床资料、供体一般临床资料及受体术中相关变量,采用Logistic回归模型分析影响肝移植术后EAD的相关危险因素,绘制ROC曲线分析相关危险因素对肝移植术后EAD的预测价值。结果术后7d、术后14d与术后1d比较,3组血清总胆红素(TBiL)、丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)水平均降低,有显著差异(P<0.05);中CIT组、长CIT组与短CIT组比较,各时间点TBiL、ALT、AST水平均升高,有显著差异(P<0.05);长CIT组与中CIT组比较,各时间点TBiL、ALT、AST水平均升高,有显著差异(P<0.05)。Logistic回归模型多因素分析显示:受体MELD评分、供体年龄、CIT、术中失血量均是肝移植术后EAD的独立危险因素(P<0.05)。ROC曲线结果显示:受体MELD评分、供体年龄、CIT、术中失血量及联合预测对于预测肝移植术后EAD均具有统计学意义(P<0.05),其中联合预测的AUC=0.946,95%CI为0.913~0.978,灵敏度为0.903,特异度为0.929,预测价值较高。结论CIT延长会加重肝移植患者术后EAD,且受体MELD评分、供体年龄、CIT、术中失血量是肝移植术后EAD的独立危险因素。因此在肝移植术中医护人员需综合管控上述因素,以提升手术配合及手术成功率,加速患者术后康复.Objective To investigate the effect of cold ischemia time(CIT)on early graft function after liver transplantation,and to analyze the related risk factors of early graft dysfunction(EAD).Methods A total of 387 patients who underwent liver trans-plantation in our hospital from January 2020 to June 2024 were selected.According to the donor liver CIT,the recipients were divided into short CIT group(CIT≤6 h,162 cases)and medium CIT group(6 h10 h,79 cases).The liver function indexes of the three groups at 1 d,7 d and 14 d after operation were compared.At the same time,all recipients were divided into EAD group(n=62)and non-EAD group(n=325)according to the EAD after liver transplantation.The general clinical data of the two groups of recipients be-fore operation,the general clinical data of donors and the related variables of recipients during operation were compared.Logistic re-gression model was used to analyze the related risk factors affecting EAD after liver transplantation,and ROC curve was drawn to ana-lyze the predictive value of related risk factors on EAD after liver transplantation.Results The levels of serum total bilirubin(TBiL),alanine aminotransferase(ALT)and aspartate aminotransferase(AST)in the three groups were significantly lower than those in the first day after operation(P<0.05).Compared with the middle CIT group,the long CIT group and the short CIT group,the levels of TBiL,ALT and AST increased at each time point,and there were significant dfferences(P<0.05).Compared with the medium CIT group,the levels of TBiL,ALT and AST in the long CIT group were significantly higher at each time point(P<0.05).Multivariate analysis of Logistic regression model showed that MELD score,donor age,CIT and intraoperative blood loss were independent risk factors for EAD after liver transplantation(P<0.05).The results of ROC curve showed that MELD score,donor age,CIT,intraoperative blood loss and combined prediction were statistically significant for predicting EAD after liver transplantation(P<0.05).The AUC of combin

关 键 词：冷缺血时间 肝移植 移植物功能 影响 危险因素 围术期手术配合 

分 类 号：R575[医药卫生—消化系统]