肝移植术后腹内高压与急性肾功能衰竭的关系

Relationship between intra-abdominal hypertension and acute renal failure after liver transplantation

目的探讨肝移植术后腹内高压(IAH)与急性肾功能衰竭(ARF)的关系。方法回顾分析62例肝移植患者的临床相关资料,确定ARF的诊断标准;采用膀胱内压检测法间接测量腹内压,术后前3d内每天腹内压超过20mmHg者为IAH,比较IAH组与非IAH组在术后3d的腹内压值和血清肌酐、尿素氮水平及肾小球滤过梯度、每小时尿量以及平均动脉压的变化。采用多元相关性分析、Logistic回归方法分析肝移植术后ARF发生的相关危险因素。结果IAH组24例患者中,11例(45.8%)发生ARF,术后前3d肾小球滤过梯度显著降低,血清肌酐和尿素氮的水平显著升高,每小时尿量显著减少;非IAH组38例患者中,仅有3例(7.9%)发生ARF,两组比较,差异有统计学意义(P<0.05)。多元相关性分析提示,患者年龄≥60岁、术中输血量≥3000ml、术中MAP降低、术后IAH、感染、急性肺损伤等与肝移植术后ARF的发生明显相关;回归分析提示,术中输血量≥3000ml、术中MAP降低、术后IAH是ARF发生的独立危险因素;多元逐步回归分析显示,术中输血量≥3000ml、术中MAP降低及术后IAH是ARF发生的高度危险因素。结论IAH是ARF发生的独立高度危险因素;严密监测术后腹内压的变化,对预防与减轻ARF具有较重要的临床意义。

Objective To investigate the relationship between intra-abdominal hypertension （IAH） and acute renal failure （ARF） after liver transplantation. Methods The clinical data of 62 cases of liver transplantation were retrospectively analyzed. Intra-ahdominal pressure was indirectly measured by intravesical pressure method. On the first 3 days after operation, intra-abdominal pressure over 20 mm Hg every day was regarded as IAH. Post-operative intra-ahdominal pressure, serum creatinine and urea nitrogen levels, urine volume per h, glomerulus filtration gradient （GFG） and mean arterial pressure on the first 3 days after surgery were recorded. By using hivariahle correlations and logistic regression analysis, the perioperative risk factors for ARF were analyzed. Results In IAH group （24 patients）, in 11 cases （45.8 %） of ARF, GFG and urine volume per h were significantly lower, serum creatinine and urea nitrogen levels were significant higher than in No-IAH group on the first 3 days after operation. In No-IAH group （38 patients）, ARF occurred in only 3 cases （7.9 %） with the difference being significant between two groups （P〈0. 05）. Bivariable correlation analysis revealed that ARF was significantly correlated with age （older than 60 years）, intraoperative blood transfusion volume （more than 3000 ml）, decrease of intraoperative mean arterial pressure and postoperative IAH, postoperative sepsis, postoperative acute lung injury. Logistic and step wise regression analysis suggested that intraoperative blood transfusion volume （more than 3000 ml）, decrease of intraoperative mean arterial pressure and postoperative IAH were independent risk factors for ARF. Conclusion IAH impaired renal function and was an independent risk factor for ARF after liver transplantation. It is worth monitoring intra-abdominal pressure in those subjects.