影响肝移植术后早期预后的相关危险因素分析

Analysis of risk factors related to early prognosis after orthotopic liver transplantation

目的探讨影响肝移植术后早期预后的相关的危险因素。方法回顾性的分析了我院自2003年1月1日至2003年10月31日的原位肝移植病例171例。根据术后早期预后分为预后不良组及非预后不良组(术后早期住院期间死亡者或因各种并发症术后>7 d转出ICU者定为预后不良的病人),比较两组病人术前及术中的变量13项;并筛选出影响预后的一些变量。结果171例病人中,预后不良者30人(17.5%),其中围手术期死亡12人(7%);应用单因素分析比较预后不良及非预后不良病人的各项指标,以下参数均具有显著性差异:Child分级、APACHEⅢ评分、UNOS分级、手术时间、出血量、输血及血浆量、术前Cr水平、术前ICU、术前感染及再次手术干预。将预后作为因变量进行Logistic回归分析,筛选影响预后的危险因素,保留在回归方程中的变量有:APACHEⅢ评分、术前感染、手术时间、术中出血和输血量。而病人年龄、CHILD分级、UNOS分级、无肝期、术前Cr、术前ICU停留、再次手术干预被剔除方程。结论通过对肝移植病人术前及术中一些指标的评估,可以在一定程度上预测术后早期的预后。

Objective To investigate the risk factors related to early prognosis after orthotopic liver transplantation （OLT）. Methods The clinical data of 171 patients receiving OI.T in our hospital from January 2003 to October 2003 were retrospectively analyzed. Based on the early prognosis after OLT, the 171 patients were divided into the poor prognosis group including those died early after the operation or stayed in ICU over 7 d for various complications and the non poor prognosis group. Thirteen variables were analyzed in both groups before and during the operation to screen out several variables affecting the early prognosis. Results The poor-prognosis group included 30 patients （17.5%） and 12 of them died during the perioperative period. There were significances between the 2 groups in the following variables： Child Pugh classification, APACHE Ⅲ score, duration of operation, volume of hemorrhage and transfusion, pre-OLT serum creatinine level, pre-OLT ICU stay, pre OLT infection and reoperation. Analysis of the relationship between multivariate risk factors and prognosis after OLT by logistic regression showed that APACHE III score, pre OLT infection, duration of operation, volume of hemorrhage and transfusion were risk factors. Conclusions Some variables before or during the operation can be used as indexes predicting the early prognosis of OLT.