连续性MELD评分在肝硬化患者外科手术中的临床意义

The clinical significance of continuous MELD score in surgical treatment of patients with cirrhosis

目的回顾性分析连续性MELD评分在肝硬化患者外科手术中的临床意义。方法选择我院就诊的肝硬化且需手术的患者164例,按MELD评分分为A组62例(15≤MELD<20),B组80例(20≤MELD<25),C组22例(MELD≥25)。对比患者术后第1天和第7天血生化指标ALT、AST、γ-GGT、TBIL、SCr变化。对三组患者进行连续性MELD评分及对并发症发生率、病死率及预后进行分析。结果术后第1天各组患者各项血生化指标两两对比差异均有统计学意义,(P<0.05)。第7天三组患者ALT、AST、γ-GGT差异均无统计学意义,但TBIL、SCr对比差异均有统计学意义,(P<0.05)。各组患者术后发生并发症及死亡例数两两相比较差别有统计学意义。各组内不同预后MELD评分相比较,差异有统计学意义。结论 MELD评分能在一定程度上简单、客观、连续地评价肝硬化患者外科手术后的预后,对积极预判及诊治肝硬化患者并发症有临床指导意义。

Objective To analyze the clinical significance of the continuous MELD score in the surgical treatment of patients with cirrhosis retrospectively.Methods To select 164 patients with cirrhosis those who need to receive operation in our hospital. According to the MELD score,there were 62 cases in group A( 15≤MELD<20),80 cases in group B( 20≤MELD< 25),22 cases in group C( MELD≥25). The changes of biochemical indicators including ALT,AST,γ-GGT,TBIL,SCr at the first day and the seventh day after the surgery were compared. The MELD score of the three groups was analyzed and the complications,mortality and prognosis were analyzed. Results The differences of blood biochemical indexes among the three groups were statistically significant at first days after operation,P< 0.05. On the seventh day,the differences of ALT,AST,and γ-GGT among the three groups were not statistically significant,but the differences of TBIL and SCr among the three groups were statistically significant,P<0.05.Differences of postoperative complications and death among the three groups were statistically significant. There were significant differences in MELD scores among different groups.Conclusions To a certain extent,the MELD score can be a simple,objective,and continuous assessment of the prognosis after surgery for patients with cirrhosis,and has clinical significance for active pre-diagnosis and diagnosis and treatment of complications in patients with cirrhosis.