CAJ | 학술논문

目的分析经典原位肝移植术后早期受者发生急性呼吸窘迫综合征(ARDS)的相关危险因素.方法以经典原位肝移植受者为研究对象,年龄为15～69岁,术前无慢性呼吸系统疾病和低氧血症,按剔除条件筛选后,最终251例纳入研究,按术后当天ARDS发生情况分为无ARDS组(187例)和ARDS组(64例).纳入分析的因素有:(1)受者性别、年龄、体重;(2)受者术前Child-Pugh分级、终末期肝病模型(MELD)评分、左心室射血分数、术前各项临床化验指标[氧合指数、血清肌酐、血清尿素氮、血清胆红素总量、血清白蛋白、血清前白蛋白、血红蛋白、血小板计数、白细胞计数、国际标准化比值(INR)、纤维蛋白原];(3)供者年龄、供肝热缺血和冷缺血时间;(4)手术持续时间、无肝期、术中出血量、输血量、输液量;(5)术后第1天的各项临床化验指标(血清肌酐、血清尿素氮、血清胆红素总量、血清白蛋白、谷氨酸转氨酶、血红蛋白、血小板计数、白细胞计数、INR、纤维蛋白原、血清钠、血清钾).结果 ARDS组中,12例(4.8％)发生中重度ARDS.单因素分析中,两组受者年龄、术前Child-Pugh分级、术前MELD评分、术前血清尿素氮、术前胆红素总量、术前前白蛋白、术前血红蛋白、术前白细胞计数、术前INR、术前纤维蛋白原、术中出血量、术中输血总量、术中输红细胞悬液量和血浆量、术后血清尿素氮、术后胆红素总量、术后血清钠、术后血红蛋白、术后血小板计数、术后白细胞计数、术后INR、术后纤维蛋白原的差异均有统计学意义(P＜0.05或P＜0.01).Logistic多因素分析中,与ARDS发生相关的因素包括受者年龄、术前Child-Pugh分级、术前INR、术前血清尿素氮、术中出血量、术后当天血清钠.结论原位肝移植后早期轻度ARDS的发生率高于中重度ARDS的发生率.患者年龄、术前Child-Pugh分级、术前血清尿素氮、术前INR、术中出血量、术后当天血清钠可能是原位肝移植术后早期ARDS发生的主要危险因素. 目的分析經典原位肝移植術後早期受者髮生急性呼吸窘迫綜閤徵(ARDS)的相關危險因素.方法以經典原位肝移植受者為研究對象,年齡為15～69歲,術前無慢性呼吸繫統疾病和低氧血癥,按剔除條件篩選後,最終251例納入研究,按術後噹天ARDS髮生情況分為無ARDS組(187例)和ARDS組(64例).納入分析的因素有:(1)受者性彆、年齡、體重;(2)受者術前Child-Pugh分級、終末期肝病模型(MELD)評分、左心室射血分數、術前各項臨床化驗指標[氧閤指數、血清肌酐、血清尿素氮、血清膽紅素總量、血清白蛋白、血清前白蛋白、血紅蛋白、血小闆計數、白細胞計數、國際標準化比值(INR)、纖維蛋白原];(3)供者年齡、供肝熱缺血和冷缺血時間;(4)手術持續時間、無肝期、術中齣血量、輸血量、輸液量;(5)術後第1天的各項臨床化驗指標(血清肌酐、血清尿素氮、血清膽紅素總量、血清白蛋白、穀氨痠轉氨酶、血紅蛋白、血小闆計數、白細胞計數、INR、纖維蛋白原、血清鈉、血清鉀).結果 ARDS組中,12例(4.8％)髮生中重度ARDS.單因素分析中,兩組受者年齡、術前Child-Pugh分級、術前MELD評分、術前血清尿素氮、術前膽紅素總量、術前前白蛋白、術前血紅蛋白、術前白細胞計數、術前INR、術前纖維蛋白原、術中齣血量、術中輸血總量、術中輸紅細胞懸液量和血漿量、術後血清尿素氮、術後膽紅素總量、術後血清鈉、術後血紅蛋白、術後血小闆計數、術後白細胞計數、術後INR、術後纖維蛋白原的差異均有統計學意義(P＜0.05或P＜0.01).Logistic多因素分析中,與ARDS髮生相關的因素包括受者年齡、術前Child-Pugh分級、術前INR、術前血清尿素氮、術中齣血量、術後噹天血清鈉.結論原位肝移植後早期輕度ARDS的髮生率高于中重度ARDS的髮生率.患者年齡、術前Child-Pugh分級、術前血清尿素氮、術前INR、術中齣血量、術後噹天血清鈉可能是原位肝移植術後早期ARDS髮生的主要危險因素.
목적 분석경전원위간이식술후조기수자발생급성호흡군박종합정(ARDS)적상관위험인소.방법 이경전원위간이식수자위연구대상,년령위15～69세,술전무만성호흡계통질병화저양혈증,안척제조건사선후,최종251례납입연구,안술후당천ARDS발생정황분위무ARDS조(187례)화ARDS조(64례).납입분석적인소유:(1)수자성별、년령、체중;(2)수자술전Child-Pugh분급、종말기간병모형(MELD)평분、좌심실사혈분수、술전각항림상화험지표[양합지수、혈청기항、혈청뇨소담、혈청담홍소총량、혈청백단백、혈청전백단백、혈홍단백、혈소판계수、백세포계수、국제표준화비치(INR)、섬유단백원];(3)공자년령、공간열결혈화랭결혈시간;(4)수술지속시간、무간기、술중출혈량、수혈량、수액량;(5)술후제1천적각항림상화험지표(혈청기항、혈청뇨소담、혈청담홍소총량、혈청백단백、곡안산전안매、혈홍단백、혈소판계수、백세포계수、INR、섬유단백원、혈청납、혈청갑).결과 ARDS조중,12례(4.8％)발생중중도ARDS.단인소분석중,량조수자년령、술전Child-Pugh분급、술전MELD평분、술전혈청뇨소담、술전담홍소총량、술전전백단백、술전혈홍단백、술전백세포계수、술전INR、술전섬유단백원、술중출혈량、술중수혈총량、술중수홍세포현액량화혈장량、술후혈청뇨소담、술후담홍소총량、술후혈청납、술후혈홍단백、술후혈소판계수、술후백세포계수、술후INR、술후섬유단백원적차이균유통계학의의(P＜0.05혹P＜0.01).Logistic다인소분석중,여ARDS발생상관적인소포괄수자년령、술전Child-Pugh분급、술전INR、술전혈청뇨소담、술중출혈량、술후당천혈청납.결론 원위간이식후조기경도ARDS적발생솔고우중중도ARDS적발생솔.환자년령、술전Child-Pugh분급、술전혈청뇨소담、술전INR、술중출혈량、술후당천혈청납가능시원위간이식술후조기ARDS발생적주요위험인소.
Objective To analyze related perioperative risk factors of acute respiratory distress syndrome (ARDS) early after orthotopic liver transplantation (OLT).Methods The cases from the recipients having undergoing OLT,aged from 15 to 65 years and having no chronic respiratory diseases and hyoxemia were collected.The exclusive criteria were as follows:(1) the patients dead or automatic discharging at the day after the OLT or during the OLT; (2) the patients suffered from severe surgical technic complications; (3) initial poor graft function occurred; (4) marginal donor; (5) pulmonary wedge pressure (PAWP)＞ 2.394kPa.251 patients were enrolled in this analysis,who were grouped according to whether they developed ARDS (group B) or not (group A) in the first postoperative day.The analyzed factors were as follows:(1) the sex,age and weight of the recipients; (2) preoperative variables of recipients:Child-Pugh and Model for end-stage liver disease (MELD) score,left vent ricular ejection fractions,oxygenation index,the serum levels of creatinine,BUN,TB,albumin,prealbumin,fibrinogen and hemoglobin,white blood cells (WBC),platelet count and international normalized ratio (INR) ; (3) the variables of donator:age,the time of warm and cold ischemia; (4) the intraoperative variables:operative time,anhepatic phase,the volumes of hemorrhage and blood-transfusion (red cell suspension and plasma),transfusion volume; (5) postoperative variables of recipients:the serum levels of creatinine,blood urea nitrogen (BUN),total bilirubin (TB),albumin,alanine aminotransferase (ALT),sodium and potassium,fibrinogen and hemoglobin,WBC,platelet count and INR.Results The mild ARDS incidence early after OLT was 25.5 ％ (65/251) and the moderate or severe was 4.8％ (12/265).Single factor analysis showed that the factors having significant difference between group A and group B were as follows:the age of the recipients,preoperative variables (Child-Pugh and MELD score,the preoperative serum levels of BUN,TB,prealbumin,fibrinogen and hemoglobin,WBC,platelet count and INR),the intraoperative variables (the volumes of hemorrhage and blood-transfusion including red cell suspension and plasma) and the postoperative variables (the serum levels of BUN,TB,sodium,fibrinogen and hemoglobin,WBC,platelet count and INR).The significant factors were put to the analysis of LOGISTIC regression,and the results showed that the age of recipients,preoperative Child-Pugh score,BUN and INR,intraoperative hemorrhage volume,postoperative serum level of sodium were the independent risks contributing to ARDS.Conclusion The mild ARDS incidence early after OLT was high but the the moderate or severe incidence was low.The age of recipients,preoperative Child-Pugh score,BUN and INR,intraoperative hemorrhage volume and postoperative serum level of sodium may be the main risk factors to lung injury after OLT.