成人原位肝移植术后早期急性肺损伤危险因素的临床研究

Clinical research of risk factors of early acute lung injury after orthotopic liver transplantation in adults

目的 分析成人原位肝移植术后早期急性肺损伤的相关危险因素,为更好地预防和治疗肺损伤提供临床依据。方法 回顾性分析2013年1~12月武警总医院82例成人原位肝移植患者临床资料,按照肝移植术后早期是否发生肺损伤,将患者分为急性肺损伤组和非急性肺损伤组,比较两组性别、年龄、基础疾病、术前凝血功能、手术时间、术中输血量及无肝期时间。采用多因素Logistic回归分析探讨造成原位肝移植患者术后急性肺损伤的影响因素。结果 共39例出现急性肺损伤,发生率为47.56%。单因素分析显示,急性肺损伤组和非急性肺损伤组肝硬化失代偿期或重型肝炎情况、移植前存在凝血功能异常情况、移植术中输血量、无肝期时间差异有统计学意义（P〈0.05）。多因素Logistic回归分析显示,造成原位肝移植患者术后急性肺损伤的影响因素包括移植前凝血功能异常、肝硬化失代偿期或重型肝炎、移植术中输血量及无肝期时间（P〈0.05）。结论 基础疾病为肝硬化失代偿或重症肝炎、术前凝血功能异常、术中大量输血、无肝期时间长是肝移植术后早期发生肺损伤的重要危险因素,临床应合理控制,从而提高肝移植患者的生存率。

Objective To analyze the risk factors of early acute lung injury after orthotopic liver transplantation in adults, in order to provide reference for early prevention and treatment of lung injury after liver transplantation. Methods The clinical data of 82 cases of patients with orthotopic liver transplantation in General Hospital of Armed Police from January to December 2013 were retrospectively analyzed. According to whether early lung injury occurred after liver transplantation,the patients were divided into the acute lung injury group and the non-acute lung injury group.The gender, age, basic disease, preoperative coagulation function, operation time, intraoperative blood transfusion volume, anhepatic period were compared between the two groups. Multi-factor Logistics regression analysis was used to analyze the influence factors of acute lung injury after orthotopic liver transplantation. Results 39 cases of patients had acute lung injury, the incidence was 47.56%. Single factor analysis showed that there were statistically significant differences in decompensated liver cirrhosis or severe hepatitis, coagulation disorders before transplantation, intraoperative blood transfusion volume, anhepatic period between the acute lung injury group and the non-acute lung injury group（P 0.05）. Multi-factor Logistic regression analysis showed that the influence factors of early acute lung injury after orthotopic liver transplantation were coagulation disorders before transplantation, decompensated liver cirrhosis or severe hepatitis, intraoperative blood transfusion volume and anhepatic period（P 0.05）. Conclusion Decompensated liver cirrhosis or severe hepatitis, coagulation disorders before transplantation, a large number of blood transfusions, long anhepatic period are the risk factors of early acute lung injury after orthotopic liver transplantation, which should be controlled in clinic, so as to enhance the survival rate of liver transplantation patients.