肝移植患者术后早期死亡原因分析

Multivariate regression analysis on early death after orthotopic liver transplantation

目的 探讨影响肝移植术后早期死亡率的危险因素。方法 回顾性分析 37例成人肝移植的临床资料 ,术后存活 30d的 2 7例患者为生存组 ,术后存活时间 <30d的 10例为死亡组 ,对患者常合并的多种危险因素进行StepwiseLogistic回归分析。 结果 肝移植术后早期死亡率与危重病评分 (ApacheⅢ评分 )、术前血肌酐水平和术中出血量存在明显相关性 ,相关系数分别为0 .184 1、0 .2 0 5 6和 0 .3738。结论 ApacheⅢ评分、术前血肌酐水平和术中出血量是导致肝移植术后早期死亡率升高的重要风险因素 ;改善术前受者合并的危重病情和肾功能 ,减少术中出血量 ,能够降低肝移植术后的早期死亡率。

Objective To identify the risk factors relative to early death after orthotopic liver transplantation.Methods Clinical data of 37 adult patients undergoing liver transplantation were retrospectively collected. They were divided into two groups: the survival group (survival time≥30 days, n =27) and dead group (survival time<30 days, n =10). The relationship between multivariate risk factors and early death after orthotopic liver transplantation was analyzed by stepwise logistic regression. Results Survival rate was 73% and early mortality was 27 %. Apache Ⅲ scores, preoperative serum creatinine level and interoperative bleeding amount had significant independent association with early death with the R = 0.1841 , 0.2056 and 0.3738 respectively.Conclusion Apache Ⅲ scores, preoperative serum creatinine level and interoperative bleeding amount were significent risk factors responsible for early death after orthotopic liver transplantation. To improve the recipient's preoperative critical condition and renal function and to decrease interoperative bleeding amount can ameliorate the early mortality after orthotopic liver transplantation.