成人首次肝移植术后早期死亡的相关因素分析

Relevant factors of the early mortality after first liver transplantation in adults:a retrospective analysis

目的探讨影响成人首次肝移植术后早期(术后90 d内)死亡的相关因素,为提高肝移植术后生存率提供一定的科学依据。方法回顾性分析本院2004年8月至2011年2月所施行的218例肝移植患者的临床资料。对术前、术中共46个变量进行单因素分析,将有统计学差异的变量一并纳入Logistic回归分析,筛选出独立的相关因素。结果剔除不符合研究条件的3例,218例参与本次研究,早期死亡34人(15.6%)。单因素分析提示多项因素与术后早期死亡有关。Logistic回归分析筛选出影响死亡的独立相关因素有:肝性脑病(HE)、手术时间、术中输血量、术中尿量。结论多种因素可导致成人首次肝移植术后早期死亡,术前纠正HE、肝肾综合征(HRS)、改善凝血功能、改善营养状态、改善内环境,有助于降低术后病死率。

Objective To investigate the relevant factors of early mortality in adult recipients after first liver transplantation（LT） and to provide scientific basis for improving postoperative survival.Methods The clinical data of 218 cases undergoing LT between Aug.2004 and Feb.2011 in Nanfang Hospital were studied retrospectively.Those of significance in 46 pre-and intraoperative factors,which were based on univariate analysis,were analyzed by means of Logistic regression to screen for independent relevant ones.Results Thirty-four out of 218 cases（15.6%） died in early stage after excluding 3 unavailable ones died in early stage after operation（postoperative 90 days） were studied.Diverse factors related to early mortality were studied with univarate analysis.Consequences of multifactor Logistic regression analysis showed that 4 factors were independent related factors of early mortality after LT,including preoperative hepatic encephalopathy（HE）,duration of operation,intraoperative total blood transfusion,and intraoperative total urine.Conclusion Diverse factors can cause early mortality after LT.Postoperative death rate can be reduced by preoperative therapy of HE,hepatorenal syndrome（HRS）,improvement of coagulative function,nutritional status and internal environment.