非静脉转流原位肝移植围术期肾功能变化

Changes of perioperative renal function in patients undergoing othortopic liver transplantation without venovenous bypass

目的探讨非静脉转流原位肝移植围术期肾功能变化。方法根据无肝期是否使用体外静脉—静脉转流(venovenousbypass,VVB),分为非转流组(n=26)和转流组(n=29)。测定围术期血清肌酐(serumcreati-nine,Cr)和血清尿素氮(bloodureanitrogen,BUN)。又根据术后有无肾功能不全将病人分为有肾功能损害组(A组)和无肾功能损害组(B组)。结果非转流组与转流组术后血清Cr和BUN均明显高于术前(P<0.05);两组之间无明显差异(P>0.05)。有肾功能损害组术前血清BUN、血清总胆红素、术前肝功能ChildC级人数、术前血清血Cr或血BUN增高人数明显高于无肾功能损害组(P<0.05),术中出血及输血量明显高于无肾功能损害组(P<0.05)。结论非静脉转流原位肝移植与VVB原位肝移植,术后均易出现肾功能损害。术前肝功能严重障碍、肾功能不全及术中大量出血是造成术后急性肾功衰的主要原因。

[Objective] To investigate the changes of perioperative renal function in patients undergoing othortopic liver transplantation without veno-venoous bypass （VVB）. [Methods] Patients were divided into two groups： VVB group （n =29） which undergoing othortopic liver transplantation with VVB, and non-VVP group （n =26） which undergoing Othortopic Liver transplantation without VVB. Perioperative serum creatinine （Cr） and blood urea nitrogen （BUN） were measured. According to the postoperative renal function, the patients were divided into two groups： group A which suffered from postoperative renal dysfunction and group B with normal postoperative renal function. [Results] In both non-VVB group and VVB group, postoperative serum Cr and BUN were higher than the preoperative values, respectively （P 〈0.05）. There were no significant differences in serum Cr and BUN between two groups, respectively （P 〉0.05）. Preoperative BUN, serum total bilirubin （TB） in group A were higher than those in group B （P 〈0.05）. The number of patients with preoperative hepatic dysfunction （Child-pugh score C） and the number of preoperative renal dysfunction （serum Cr or BUN increased） in group A were higher than those in group B （P 〈0.05）. The amount of intraoperative bleeding and transfusion in group A were higher than those in group B （P 〈 0.05）. [Conclusion] Renal dysfunction is prone to occur after othortopic liver transplantation, with or without VVB. Preoperative hepatic or renal dysfunction and intraoperative hemorrhea are chief causes of postoperative acute renal failure.