肝移植术后并发急性肾功能衰竭的相关危险因素分析

Risk factors of acute renal failure complicated to orthotopic liver transplantation

目的探讨肝移植术后并发急性肾功能衰竭(ARF)的相关危险因素。方法对62例肝移植患者的临床资料进行回顾性分析,根据术后是否发生ARF,将62例分为肾衰组(23例)和无肾衰组(39例)。以术前、术中及术后常用的临床及实验室指标共计29项作为危险因素的分析对象,先对这些指标进行单因素分析,将单因素分析有统计学意义的指标再进行Stepwiselogistic回归分析。结果计量资料中,术前血胆红素总量、术前腹水量、术中失血量、术中血制品输入量及无肝期时间等指标,两组间的差异有统计学意义;计数资料中,术前是否需要重症监护、术前有无肝性脑病、术中有无低血压及术后有无感染等指标,两组间的差异有统计学意义。对上述9项指标进行Stepwiselogistic回归分析,术中失血量多和术后感染是肝移植术后并发ARF的两个独立危险因素。结论肝移植术后并发ARF的原因可能是多方面的,术后感染和术中失血量多是肝移植术后并发ARF的独立危险因素。

Objective To study the risk factors of acute renal failure (ARF) complicated to orthotopic liver transplantation (OLT).Methods The clinical data of 62 patients undergoing OLT were analyzed, which were divided into two groups: patients with ARF (23 cases) and patients without ARF (39 cases). Twenty-nine variables, including clinical and experimental variables, were analyzed by t test for continuous variables and χ~2 test for discrete variables. The variables with significance (P<(0.05)) were then analyzed with stepwise logistic regression.Results Five continuous variables,(including) preoperative blood total bilirubin concentration, volume of preoperative ascites, volume of (intraoperative) blood-loss, volume of intraoperative blood transfusion and duration of anhepatic phase, had significant difference between two groups. Four discrete variables, including preoperative ICU care, preoperative hepatic encephalopathy, intraoperative low blood pressure and postoperative infection, had significant difference between two groups. The stepwise logistic regression analysis for 9 variables demonstrated that volume of intraoperative blood-loss and postoperative infection were the (independent) risk factors of ARF complicated to OLT.Conclusion The reason for ARF complicated (to OLT) is multiple. Postoperative infection and volume of intraoperative blood-loss are the (independent) risk factors of ARF complicated to OLT.