肝移植病人术后急性肾功能衰竭18例临床分析

Clinical analysis of risk factors leading to post-liver transplantation acute renal failure (a report of 18 cases)

目的:探讨影响肝移植术后发生急性肾功能衰竭的原因及处理方法。方法:回顾性分析我院91例肝移植病人中发生与未发生术后急性肾功能衰竭病人的临床资料,采用单因素分析和Logistic回归模型进行多因素分析。结果:肾衰组病人1年生存率低于对照组;与术后发生早期急性肾功能衰竭的有关因素包括术前血清肌酐、总胆红素、总手术时间、术中出血量、输血量、术中输液总量、术中尿量。术前血清肌酐高和术中尿量是术后早期急性肾功能衰竭发生的独立影响因素。移植术后发生急性肾功能衰竭的病人ICU留置时间延长,术后住院时间延长,住院费用升高。结论:肝移植术后有较高的急性肾功能衰竭发生率,对术后少尿、血清肌酐水平升高的病人及早实施肾脏替代等治疗能有效降低其发病率和死亡率。

Objective To discuss the risk factors of acute renal failure（ARF） in the early post-liver transplantation period and its management. Methods A retrospective analysis concerning post-operative acute renal failure was made in 91 patients undergoing liver transplantation. Univariate logistic regression analysis and multivariate logistic regression analysis were used to determine the risk factors leading to post-liver transplantation ARF. Results The one year survival rate in the ARF group was lower than that of the non-ARF group. The risk factors of ARF included pretransplant serum creatinine,total bilirnbin,total operation time,intraoperative blood loss,intraoperative blood transfusion,total intraoperative fluid transfusion,preoperative urine output. Logistic regression showed pretransplant serum creatinine and preoperative urine output were independent factors associated with post-liver transplantation ARF. Intensive care unit hospitalization time and total hospitalization time were longer and the average cost was higher in the ARF group than that in the non-ARF group. Conclusions Early continuous renal replacement therapy can reduce the morbidity and mortality rates when postliver transplantation ARF occurs.