再灌注期低体温对慢性重型肝炎患者肝移植术后急性肺水肿的影响

Impact of core hypothermia during reperfusion on acute pulmonary edema after liver transplantation in patients with chronic severe hepatitis

目的探讨再灌注期低中心体温对慢性重型肝炎患者肝移植术后急性肺水肿（APE）的影响。方法回顾性分析2002年2月至2006年12月间诊治的108例慢性重型肝炎肝移植患者的临床资料。比较肝移植术后急性肺水肿（APE组）和无急性肺水肿（NAPE组）患者再灌注期低体温持续时间，及其对输血量和新肝期凝血酶原时间（PT）的影响。结果108例患者中有41例在肝移植术后发生不同程度的APE（37．96％）。APE组患者再灌注期体温比NAPE组更低（t=2．413，P=0．018），低体温持续时间超过5min的病例数更多（39．02％，χ^2=143．40）。APE组患者新肝期盯延长更加明显（t=2．884，P=0．005），输血量更大。低体温组患者与对照组比较，新肝期PT更长[分别为（28．03±8．45）min和（24．12±5．89）min，t=2．553，P=0．012]，输注的红细胞量[分别为（2786．96±1266．47）ml和（2129．41±805．90）ml，t=2．364，P=0．026）和血浆量均更多[分别为（2121．74±676．19）ml和（1768．24±685．08）ml，t=2．201，P=0．030]。结论再灌注期中心体温过低增加慢性重型肝炎肝移植术后急性肺水肿的发生率，可能与凝血酶原时间延长、增加输血量有关。

Objective To investigate the influence of hypothermia during reperfusion on acute pulmonary edema （ APE ） after liver transplantation in patients with chronic severe hepatitis. Methods Between February 2002 and December 2006, 108 consecutive patients of chronic severe hepatitis underwent liver transplantation. Patients suffering from postoperative APE （APE group） were compared with those without APE （NAPE group ）on hypothermia during reperfusion. We evaluated the impact of hypothermia on requirement of red blood cells and/or fresh-frozen plasma, and prothrombin time in neo-liver phase. Results Forty-one out of these 108 （ 37.96% ） cases were complicated with APE. Compared with NAPE group, patients in APE group have significant lower core hypothermia（t =2. 413 ,P =0. 018）, longer hypothermia duration （ 〉 5 min） （39. 02%, X^2 = 143.40）. Longer prothrombin time（ t = 2. 884 ,P = 0. 005 ） and larger amount of blood transfusion were observed in APE group. Patients with hypothermia were prone to accompanied with longer PT in neo-liver phase （28. 03 ± 8.45 ） min vs （24. 12 ± 5.89） min, t = 2. 553, P=0. 012）, larger requiring of RBC transfusion （2786. 96 ± 1266.47） ml vs （2129. 41 ±805.90） ml, t = 2.364, P=0.026） and fresh-frozen plasma （2121.74 ±676.19） ml vs （1768.24±685.08） ml, t = 2. 201, P = 0. 030）. Conclusions Low core hypothermia during neo-liver reperfusion contributes to the development of APE in patients with chronic severe hepatitis undergoing liver transplantation. Prolonged PT and large amount of blood transfusion may be involved in this complication.