肝移植围手术期液体治疗的对术后肺部并发症影响的临床研究

CLINICAL STUDY OF PERIOPERATIVE FLUID THERAPY INFLUENCING PULMONARY COMPLICATION AFTER LIVER TRANSPLANTATION

目的探讨肝移植术中、术后的液体治疗与术后早期肺部并发症的关系,为肝移植围手术期合理的液体治疗提供依据。方法回顾性分析肝移植受者62例,根据术后早期是否有肺部并发症分为有并发症组(并发症包括肺水肿、急性肺损伤、肺炎、ARDS)和无并发症组。比较2组患者术前、术中、术后前3d治疗中的参数20项,筛选出影响早期肺部并发症的一些变量,并比较这些变量对术后恢复情况的影响。结果62例患者中,术后早期有肺部并发症29例(46.77%),其中围手术期死亡3例(4.84%)。应用单因素分析比较有并发症组和无并发症组患者的各项参数,结果发现以下参数有统计意义:术前肺功能、术中入量、术中出血量、术中出入量差和术后前3 d至少有2 d的液体平衡≤-500 mL。将它们作为自变量、术后肺部并发症作为因变量,进行logistic多因素回归分析。筛选影响早期肺部并发症的因素,结果保留在回归方程中的变量有:术前肺功能、术中出血量和术后前3 d至少有2 d的液体平衡≤-500 mL。结论肝移植围手术期液体治疗中,术中、术后维持液体平衡是减少肝移植术后肺部并发症的重要措施,尤其是术后前3d在血液动力学稳定的前提下,适当的液体负平衡有利于受体恢复。

Objective： To investigate the correlation between intraoperative and postoperative fluid therapy and postoperative early pulmonary complication, and to provide the reasonable fluid therapy measures for the perioperative period. Method 62 patients with liver transplantation at the First Affiliated Hospital of Guangxi Medial University between July 1996 and December 2005 were retrospectively analyzed. Based on early phase prognosis after liver transplantation, these patients were divided into the non-pulmonary complication group and pulmonary complication group （including pulmonary edema, acute lung injury, pneumonia and acute respiratory distress syndrome）. Twenty perioperative variables were analyzed in both groups to screen out several variables affecting the early pulmonary complication, and then the parameters reflecting postoperative recovery were analyzed in these variables. Result The pulmonary complication group had 29 patients （ 46.77 % ） , with 3 （ 4.84 % ） deaths during the perioperative period. Using monofactorial analysis for each variable, there were significances between the two groups in the following variables： preoperative lung function, the volume of intraoperative transfusion, the volume of intraoperative bleeding, the volume of intraoperative net fluid retention and fluid balance（≤ - 500 mL） in ≥2 days of the first 3 days after operation. Analysis of the relationship between multivariate factors and pulmonary complication after liver transplantation by logistic multivariate regression analysis showed that preoperative lung function, the volume of intraoperative bleeding and fluid balance （≤ - 500 mL） in ≥ 2 days of the first 3 days after operation were influential factors. Conclusion It is impotant to maintain fluid balance during and after the operation, and as long as the haemodynamics was stable, appropriate negative fluid balance of the first 3 days of post-operation is essential to better recovery and to reducing postoperative complications of liver transplantation.