重度肝硬化患者术中出血量、尿量与术后肾功能不全的关系

Study of the Relationship between Bleeding and Urine Volume and Postoperative Renal Insufficiency in Patients with Severe Cirrhosis

目的探讨重度肝硬化患者术中出血量、尿量与术后肾功能不全的关系。方法根据术后是否存在肾功能不全将2013年8-12月第二军医大学东方肝胆外科医院收治的肝癌伴肝功能失代偿肝硬化行肝肿瘤切除术的120例患者分为肾功能正常组41例和肾功能不全组79例,回顾性分析并比较两组患者肝切除手术时间、术中出血量和尿量情况。结果术后肾功能不全组患者的手术时间较肾功能正常组长,术中出血量为[(890.4±460.7)ml],显著高于肾功能正常组[(444.2±281.3)ml](P<0.05);肾功能正常组和肾功能不全组患者的尿量分别为[(151.2±51.3)]、[(100.5±40.8)]ml/h,两组比较差异有统计学意义(P<0.05)。结论术后发生肾功能不全的重度肝硬化患者,手术时间长、出血量多、尿量少,医护人员应当早期采取干预措施,尽可能减少出血量及增加肾脏血流量,积极防治术后肾功能的恶化。

Objective To investigate the relationship of postoperative renal dysfunction and intraoperative bleeding and urine volume in patients with severe cirrhosis.Methods 120 cases of patients with severe cirrhosis were included and divided into normal renal function group（n=41）and renal insufficiency group（n=79）based on the presence of postoperative renal function.Operation time,bleeding volume and urine volume were compared and analyzed retrospectively.Results The operation time in renal insufficiency group were longer than normal renal function group,and the amount of intraoperative bleeding was890.4±460.7ml,which was significantly higher than the normal renal function group（444.2±281.3）ml（P〈0.05）.There was statistical difference of urine volume between normal renal function group（151.2±51.3）ml/h and renal insufficiency group（100.5±40.8）ml/h（P〈0.05）.Conclusion Long operation time,high volume of intraoperative bleeding and low urine output are related with the incidence of postoperative renal failure in patients with severe cirrhosis.Early interventions should be applied to reduce bleeding and increase renal blood flow,and to actively prevent the postoperative renal dysfunction.