肝移植逆灌注对术后早期肾功能的影响

Effects of retrograde reperfusion via vena cava on early renal function after orthotopic liver transplantation

目的探讨肝移植术中逆灌注法对术后早期肾功能的影响。方法回顾性分析2005年1月至2009年12月南京军区福州总医院肝移植生存期1年以上患者82例。根据其手术方式的不同分为经典原位肝移植组(经典组)29例,下腔静脉逆灌注的原位肝移植组(逆灌注组)53例。分别测定两组下腔静脉阻断时间、术中输液总量和输血制品总量、移植术后7d急性呼吸窘迫综合征(ARDS)发生率、术后7d尿量,以及术后1h、1d、2d、3d、5d、7d血肌酐和血尿素氮。结果逆灌注组的下腔静脉阻断时间显著短于经典组(P<0.05)。逆灌注组的输液总量和输血制品总量均显著少于经典组(P<0.05)。两组患者术后7dARDS发生率无明显差异,术后7d尿量差异无统计学意义。肌酐术后1d、3d、5d显著低于经典组(P<0.05)。逆灌注组术后1d、2d、5d尿素氮水平显著低于经典组(P<0.05)。结论与经典原位肝移植术相比,下腔静脉逆灌注肝移植更利于早期肾功能的恢复。

Objective To explore the effects of retrograde reperfusion via vena cava on early renal function after orthotopic liver Iransplantation. Methods Eighty-two patients underwent liver transplantation who survived more than one year from January 2005 to December 2009 were retrospectively analyzed in our hospital. The patients were divided into standard classic liver transplantation group of 29 cases （classic group） and retrograde reperfusion via vena cava liver transplantation group of 53 cases （retrograde reperfusion group）. The inferior vena cava block of time, the total intraoperative infusion and the total blood products, the incidence of ARDS within seven days after operation,urine output within seven days after operation, SCr, BUN respectively at 1 h, 1 d, 2 d, 3 d, 5 d, 7 d after operation were tested in the two group. Results The inferior vena cava block of time of retrograde reperfusion group was remarkably shorter than that of classic group （P 〈 0.05）. The total intraoperative infusion and the total blood products of retrograde reperfusion group was remarkably less than that of classic group （P 〈 0.05）. There were no significant difference between the two group in the incidence of ARDS and urine output within seven days and after operation. For Ser, retrograde reperfusion group was remarkably lower than classic group of 1 d,3 d and 5 d after operation （P 〈 0.05）, but there were no significant difference between the two group 1 h, 2 d and 7 d after operation. For BUN, retrograde reperfusion group was remarkably lower than classic group of 1 d, 2 d and 5 d after operation （P 〈 0.05）, but there were no significant difference between the two group 1 h, 3 d and 7 d after opera- tion. Conclusion Compared with the standard classic liver transplantation, the classic liver transplanta- tion with retrograde reperfusion via vena cava may significantly improve the early renal function.