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| 肝移植术中大出血对术后肾功能的影响 |
| Effect of massive hemorrhage on postoperative renal function during liver transplantation |
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| DOI：10.12089/jca.2021.01.007 |
| 中文关键词: 肝移植 大出血 肾功能 |
| 英文关键词: Liver transplantation Massive hemorrhage Renal functions |
| 基金项目:北京市医管局“扬帆计划”（ZYLX201822） |
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| 中文摘要: |
目的 分析肝移植受者止血管理资料，探讨肝移植术中大出血与术后肾功能之间的关系。
方法 回顾性分析2005年6月至2013年6月接受肝移植手术患者160例，男131例，女29例，年龄18～75岁，BMI 18～29 kg/m2 ，ASA Ⅲ或Ⅳ级。根据术中是否发生大出血将患者分为两组：非大出血组（N组）和大出血组（H组），每组80例。比较两组一般资料、术前诊断及合并疾病、术中临床资料、围术期肾功能情况以及术后并发症。
结果 H组术前诊断慢性重型肝炎比例明显高于N组（P<0.05），两组一般情况及术前合并其他疾病差异无统计学意义。与N组比较，H组经典非转流原位肝移植比例明显升高，背驮式肝移植比例明显降低，手术时间明显延长，术中出血量、红细胞输注量明显增多，尿量明显减少，肾上腺素、呋塞米使用率明显增高（P<0.05），术后1、3、7 d 尿素氮浓度明显升高（P<0.05）。术前两组肌酐、总蛋白、尿素氮、尿素浓度差异无统计学意义。两组急性肾损伤不同分期占比、术后血液透析、血液滤过发生率、术后慢性肾脏病五期比例及术后并发症差异无统计学意义。
结论 大出血患者肾上腺素、红细胞使用量明显增多，手术时间明显延长，术后肾功能明显受损。减少患者术中失血对于患者肾功能保护具有一定积极意义。 |
| 英文摘要: |
Objective To explore the relationship between massive hemorrhage during liver transplantation and postoperative renal functions by analyzing the hemostatic management data of liver transplantation recipients.
Methods There was a retrospective analysis enrolled 160 patients undergoing liver transplantation between June 2005 and June 2013, aged 18-75 years, BMI 18-29 kg/m2 , ASA physical status Ⅲ or Ⅳ. There were 80 patients in the non-hemorrhagic group (group N) and 80 patients in the hemorrhagic group (group H). The clinical characteristics, diagnosis before operation, perioperative renal functions, and postoperative complications of the patients were compared between two groups.
Results Compared with group N, there were more patients diagnosed with chronic severe hepatitis in group H (P < 0.05), more patients undergoing classic non-bypass orthotopic liver transplantation rather than piggyback orthotopic liver transplantation in group H (P < 0.05), the operation time in group H was longer (P < 0.05), blood loss during operation, usage of red blood cell infusion, and epinephrine and furosemide in group H were significantly more (P < 0.05), the urine volume during the operation in group H was less (P < 0.05), and urea nitrogen in group H was significantly higher 1, 3 and 7 days after surgery. There were no significant differences in other clinical data and complications.
Conclusion The usage of epinephrine and red blood cell infusion in group H increased and the operation time significantly prolonged. Thus, the reduction of intraoperative hemorrhage of patients is of certain positive significance for the protection of renal function. |
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