肝移植患者术前营养状况及其对术后感染的影响

Pre-operative Nutritional Situation in Liver Transplantation Patients and Its Correlation with Post-operative Infections

目的了解肝移植患者术前营养状况及其对术后感染的影响。方法收集81例行经典原位肝移植患者术前病史、体格检查及实验室检查,评估术前营养状况,并对术后是否并发感染进行随访,探讨营养状况与感染并发症的关系。结果根据体质指数结果肝移植患者营养不良发生率44.9%,主观营养评价营养不良发生率69.1%,低白蛋白营养不良发生率80.2%,低前白蛋白营养不良发生率96.1%,腹水发生率44.4%。单因素分析主观评价法营养不良分级(P<0.01)、腹水分级(P(0.001)是感染发生的独立危险因素。多因素分析主观评价法营养不良分级对术后感染OR=10.057,95%可信区间(低/高)为2.810-35.997。白蛋白营养不良分级对术后感染OR=0.324,95%可信区间(低/高)为0.112-0.938。结论肝移植患者术前营养不良发生率高,应采用全面综合营养评估法进行营养评价。相对而言,主观营养评价较有价值,主观评价法评定的营养不良是感染发生的独立危险因素。

Objective To understand the pre-operative nutritional situation in liver transplantation patients and explore its correlation with post-operative infections. Methods The medical histories, physical examinations, and laboratory test results of 81 patients who underwent liver transplantation were collected and analyzed and their nutrition statuses were assessed before operations. After the operations, there infection events were recorded and the correlation between pre-operative nutritional situation and post-operative infections were analyzed. Results Body mass index showed the malnutrition rate was 44.9% in these patients before operation, while the malnutrition rate was 69.1% by subjective global assessment （ SGA）, 80.2% by measuring the amount of serum albumin （ALB） , and 96. 1% by measuring the amount of pre-albumin. Single variable analysis showed malnutrition status （P 〈0.01 ） and ascitic fluid status （P 〈 0. 001 ） were the independent risk factors of infections, while multiple variable analysis showed malnutrition grading by SGA （OR = 10. 057; 95% CI： 2. 810-35. 997） and malnutrition by measuring ALB （OR =0. 324; 95% CI： 0. 112-0. 938） were correlated with post-operative infections. Conclusions Liver transplantation patients have severe malnutrition before operation, which may influence post-operative infections. A comprehensive pre-operational nutritional assessment, especially SGA, is required.