肝硬化门静脉高压症(PHT)术后死亡危险因素分析

Analysis of Related Risk Factor of Portal Hypertension in Patients with Liver Cirrhosis Deaths

目的:遵循循证医学的理念,通过对肝硬化门静脉高压症术后死亡原因分析,探讨肝硬化门静脉高压症术后死亡危险因素在评判手术风险中的价值,为手术风险的评估提供相对客观的依据。方法:总结分析哈医大一院1994年～2008年15年间PHT术后死亡患者51例,男:37例,女:14例,年龄38岁～62岁,平均年龄47岁。因PHT术后存活病例数量较大,本组研究选取哈医大一院2007年1年PHT(术前改良肝功能储备评分3分以上)术后存活患者51例,男31例,女20例,年龄35岁～61岁,平均年龄52岁。分别对每一位患者分4阶段(入院时、术前、术后第1天、术后第5天)进行评分,对决定患者预后的3种危险因素进行分析总结,评判手术风险。结果:术后死亡主要原因为:(1)肝功能衰竭;(2)术后持续出血或再出血;(3)难控性感染;(4)肝肾综合征。1入院时改良肝功能储备评分死亡组与对照组差异具有显著性。2术前改良肝功能储备评分较入院即时评分变化情况(潜在肝功能储备)死亡组与对照组差异具有显著性。3术前改良肝功能储备评分相同患者死亡组与对照组手术创伤评分差异具有显著性。4术后第1天、第5天改良肝功能储备即时评分变化情况死亡组与对照组差异具有显著性。结论:1肝功能储备是决定患者预后的决定性因素。2潜在肝功能储备是去除不利因素(低血容量、感染、离子紊乱、酸碱平衡失调)后,尚有功能肝细胞发挥肝脏功能的储备。动态评分可体现出潜在肝功能储备水平,亦可随时评价手术风险。术前准备和术后保持内环境稳态是调动潜在肝功能储备的关键因素。手术风险评分可基本客观反映患者手术风险,为手术适应证的选择及评估预后提供了一个可靠标准。3减少手术创伤(损伤性控制)(手术麻醉时间、术中失血)是危重患者耐受手术的前提。4术后改良肝功能储备评分不降或持续增加,预示预后不良。

Objective： To follow the concept of evidence--based medicine through the portal hypertension in patients with liver cirrhosis cause of death analysis of portal hypertension in patients with liver cirrhosis deaths related risk factor in the evaluation of the value of surgical risk, the risk of surgery for a relatively objective assessment basis. Methods： Analysis of a hospital Hayida 1994 -- 2008 years 15 years PHT operative mortality in patients with 51 cases, leading to the death of five patients with risk factors in the analysis concluded. To score, risk evaluation surgery. Results： The main reason for the deaths： （1）liver failure, （2） bleeding continued , （3）infection , （4）hepatorenal syndrome. 51 cases of patients with both risk score〉 7, and continuing irreversible, and ultimately result in death. Conclusion： Patients with liver cirrhosis and portal hypertension is a process involving surgery of liver function, renal function, acid- base balance, hydropower multiple organ system function of the complexity pathophysiological process, and is definitely not normal anatomy of the operation. Primary disease is multiple organ dysfunction, and iatrogenic injury to further increase the organ. Single organ pathological changes, poor treatment of chain-reaction can occur, leading to multiple organ failure and even death. Mortality risk score can be objectively reflect the basic surgical risk patients. It provide a reliable standard for the choice of surgical indications and prognosis to patients.