摘要
目的探讨影响肝移植患者术后并发症的高危因素,以及发生术后并发症患者的术后早期临床特征.方法回顾性分析2017年1月至2020年1月中国科学技术大学附属第一医院移植中心44例肝移植患者临床资料,根据患者是否出现手术并发症,分为对照组(无并发症发生)14例、手术并发症组9例、术后感染组11例和急性排异反应组10例.采集患者术前Child评分、血生化、血氨、凝血功能,手术时间、术中输血量和术后前4天的血生化指标、乳酸脱氢酶(LDH)、肌红蛋白(MYO)、凝血功能、血氨及他克莫司血药浓度等.结果①与对照组比较,手术并发症组患者术前Child评分较高(分:8.46±2.18 vs.10.55±1.50),胆碱酯酶降低(U/L:4515.21±1968.65 vs.2879.38±889.59),术中输血量较多(mL:2289.29±754.52 vs.4233.33±430.12),术后第1~4天血MYO、LDH和血氨都较高,术后前3天凝血酶原时间(PT)延长,差异均有统计学意义(P均<0.05).②与对照组比较,术后感染组患者术前Child评分较高(分:8.46±2.18 vs.10.90±1.57),术中输血量较多(mL:2289.29±754.52 vs.3350.00±986.15),术后第2、3、4天血氨较高,差异均有统计学意义(P均<0.05).术后他克莫司血药浓度最高值较对照组无明显升高.③与对照组比较,急性排异反应组患者术前血氨与Child评分较高(分:8.46±2.18 vs.10.80±1.31),术中输血量较多(mL:2289.29±754.52 vs.3110.00±670.74),术后第1~4天血氨升高,术后第1、3、4天LDH较高,差异均有统计学意义(P均<0.05).结论肝移植术前患者肝功能状况及对机体病理生理改变的纠正程度是决定手术成功及围术期并发症发生的关键;术后早期出现血MYO、LDH和血氨较高往往提示有发生并发症的可能.
Objective To explore the risk factors of postoperative complications in the patients with liver transplantation,and the clinical features in early period of postoperation.Methods Clinical data of 44 racmn nf liver transplantation completed in our transplant center from lanuary 2017 tn January 2020 were analyzed retrospectively.According to surgical complications,the patients were divided into the control group(no complications,14 cases),surgical complications group(9 cases),postoperative infection group(11 cases)and acute rejection group(10 cases).The blood biochemical indexes,lactate dehydrogenase(LDH),myoglobin(MYO),coagulation function,blood ammonia and tacrolimus concentration were collected.Child-Pugh scores were calculated.Results①Compared with the con-trol group,the preoperative Child-Pugh scores were higher[(8.46±2.18)scores vs.(10.55±1.50)scores],blood transfusion volume during operation were more[(2289.29±754.52)mL vs.(4233.33±430.12)mL],cholinesterase value was lower in surgical complications group[(4515.21±1968.65)U/L vs.(2879.38±889.59)U/L].MYO,LDH and blood ammonia were higher within four days after surgery.Prothrombin time(PT)was prolonged on the first three days after surgery(P<0.05).②Compared with the control group,the preoperative Child-Pugh scores were higher[(8.46±2.18)scores vs.(10.90±1.57)scores],blood transfusion volume during operation was more[(2289.29±754.52)mL vs.(3350.00±986.15)mL],the blood ammonia on the second,third and fourth day af-ter operation were relatively higher in the postoperative infection group,the diferences were staistically significant(P<0.05).After operation,the highest blood concentration of tacrolimus in the postoperative infection group was not significantly higher than that in the control group.③Compared with the control group,the preoperative blood ammonia and Child-Pugh scores were higher[(8.46±2.18)scores vs.(10.80±1.31)scorea],the transfuaion volume during operation was morc[(2289.29±754.52)mL.vs.(311000±670.74)mL]in the acute rejection gr
作者
刘海华
王锦权
陶小根
郭伟
何建三
李平
王帝
王继洲
Liu Hai-hua;Wang Jin-quan;Tao Xiao-gen;Guo Wei;He Jian-san;Li Ping;Wang Di;Wang Ji-zhou(Department of Intensive Care Unit,Anhui Provincial Hospital,the First Afiliated Hospital,Division of Life Sciences and Medicine,University of Science and Technology of China,Hefei 230036,China)
出处
《中国急救医学》
CAS
CSCD
北大核心
2020年第6期469-474,共6页
Chinese Journal of Critical Care Medicine
基金
国家自然科学基金面上项目(81772588)。
关键词
肝移植
术后并发症
Child评分
肌红蛋白
乳酸脱氢酶
Liver transplantation
Postoperative complications
Child-Pugh score
Myo-globin
Laclate dehydrogenase
