CAJ | 학술논문

目的分析急性肝功能衰竭(acute liver failure,ALF)患者肝移植术后肾功能衰竭的原因,评价以持续肾脏替代治疗(continuous renal replacement therapy,CRRT)为基础的综合疗法的疗效.方法回顾性分析2001年1月至2006年6月在我院施行的412例肝移植资料,根据UNOS肝功能分级标准筛选出54例ALF患者(UNOS1和2A),其中17例移植术后出现急性肾功能衰竭(acute renal failure,ARF).在CRRT治疗基础上,进行抗排斥、抗感染、营养支持等治疗,并对患者围手术期情况、术后并发症、死亡原因及随访结果进行了分析.结果 CRRT治疗过程中无并发症发生.无ARF组围手术期死亡率为5.4%,术后并发症发生率为35.1%,1、3年生存率分别为89.2%和81.1%.ARF组围手术期死亡率为58.8%,术后并发症发生率为100%,1、3年生存率分别为41.2%和41.2%.结论肝移植效果主要取决于肝外器官功能和术前肝功能状态.ALF患者围手术期死亡率较高,其中术前血肌酐高术后出现ARF率高,死亡率更高.以CRRT为基础的综合疗法能有效治疗ARF患者.
목적 분석급성간공능쇠갈(acute liver failure,ALF)환자간이식술후신공능쇠갈적원인,평개이지속신장체대치료(continuous renal replacement therapy,CRRT)위기출적종합요법적료효.방법 회고성분석2001년1월지2006년6월재아원시행적412례간이식자료,근거UNOS간공능분급표준사선출54례ALF환자(UNOS1화2A),기중17례이식술후출현급성신공능쇠갈(acute renal failure,ARF).재CRRT치료기출상,진행항배척、항감염、영양지지등치료,병대환자위수술기정황、술후병발증、사망원인급수방결과진행료분석.결과 CRRT치료과정중무병발증발생.무ARF조위수술기사망솔위5.4%,술후병발증발생솔위35.1%,1、3년생존솔분별위89.2%화81.1%.ARF조위수술기사망솔위58.8%,술후병발증발생솔위100%,1、3년생존솔분별위41.2%화41.2%.결론 간이식효과주요취결우간외기관공능화술전간공능상태.ALF환자위수술기사망솔교고,기중술전혈기항고술후출현ARF솔고,사망솔경고.이CRRT위기출적종합요법능유효치료ARF환자.
Objective To investigate the causes of acute renal failure(ARF)after orthtopic liver transplantation(OLT)in patients of acute liver failure(ALF)and the effects of systemic therapy based on continuous renal replacement(CRRT).Methods Clinical data of 412 patients who underwent liver transplantations between January 2001 and June 2006 were analyzed retrospectively (all the cases were followed up to June 2007).According to UNOS grading scale,54 patients were of acute liver failure(UNOS 1 and 2A).Posttransplant ARF developing in 17 cases underwent a systemic therapy based on CRRT as well as anti-rejection,anti-infection and nutrition support.The perioperative courses,complications,causes of death and follow up results were analyzed.Results There were no severe complications during CRRT.Perioperative mortality was 5.4%and 58.8%in patients without ARF and those with ARF respectively.the rate of complications was 35.1%vs 100%.1 year survival rate Was 89.2% vs 41.2%.3 year survival rate was 81.1% vs 41.2%.Condusions The effect of surgery mainly depends on the function of liver and other vital organs.The ALF recipients suffered from a high perioperative mortality,especially those with posttransplant ARL.The systemic therapy based on CRRT benefits patients with postoperative ARF.