成人活体肝移植受体术后呼吸系统并发症分析108例

Respiratory complications in adult-to-adult living donor liver transplant recipients: an analysis of 108 cases

目的:探讨活体肝移植受体术后早期(≤30d)呼吸系统并发症的类型、发病率以及原因.方法:回顾性分析2005-03/2008-09四川大学华西医院施行的术前无呼吸系统疾病的成人活体肝移植患者108例的临床资料,分析术后呼吸系统并发症(胸腔积液,肺部感染,肺不张,呼吸衰竭,肺水肿,气胸)发生可能的相关因素.结果:共76例发生了至少1种以上呼吸系统并发症,发生率为70.4%,胸腔积液(n=60,55.6%),肺部感染(n=24,22.2%),肺不张(n=12,11.2%),呼吸衰竭(n=6,5.6%),肺水肿(n=3,2.8%),气胸(n=2,1.9%).与未发生并发症组相比较,发生组术中输血量明显增加(P<0.05或0.01),术后拔除气管插管的时间明显延长(P=0.003).术后早期的总死亡率为9.3%,发生肺部感染患者的早期死亡率明显高于未发生肺部感染患者(25%vs4.8%,P=0.008).结论:胸腔积液、肺部感染、肺不张是活体肝移植术后常见的呼吸系统并发症,并可能与术中大量输血输液、术后拔管时间有关,发生肺部感染患者的早期预后将较差.

AIM： To investigate the types, incidence and risk factors of respiratory complications in adult-toadult living donor liver transplant （AALDLT） recipients in the early postoperative stage （≤30 d）. METHODS： The clinical records for 108 patients who underwent AALDLT from March 2005 to September 2008 and had no respiratory diseases preoperatively were analyzed retrospectively to identify the types and incidence of respiratory complications and the risk factors for these respiratory complications. RESULTS： Seventy-six patients （70.4%） developed at least one respiratory complication during the early postoperative period. The most frequent complication was pleural effusion （n = 60, 55.6%）, followed by pneumonia （n = 24, 22.2%）, atelectasis （n = 12, 11.2%）, acute respiratory failure （n = 6, 5.6 %）, pulmonary edema （n = 3, 2.8%）, and pneumothorax （n = 2, 1.9%）.Compared to the patients who did not develop theses problems, the affected cohort required more intraoperative transfusion （P〈0.05 or 0.01） and longer time to extubation （P = 0. 003）. The total mortality rate was 9.3%. The patients who developed pneumonia showed a significantly higher mortality （25% vs 4.8%, P = 0.008） than those who did not. CONCLUSION： Pleural effusion, pneumonia and atelectasis are common respiratory complications in AALDLT recipients in the early postoperative stage, which are related to more intraoperative transfusion and longer time to extubation. Patients who develop pneumonia have a poor prognosis.