影响肝移植术后早期死亡率的危险因素

RISK FACTORS INFLUENCING EARLY MORTALITY AFTER 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 收集我院肝移植病例资料 5 3例 ,按病人的转归分成死亡和生存两组。采集两组病人术前及术中常用的临床或实验室指标 ,先对这些指标进行单因素分析 ,将单因素分析有统计学意义的指标再进行 logistic回归分析。结果 肝功能 Child分级、术前是否重症监护、有无肝性脑病、有无肝外感染灶、血白细胞计数、血胆红素、手术时间、术中失血量、输血量和输液量等因素在单因素分析中有统计学意义 (P<0 .0 5 )。 L ogistic回归分析表明 :术前重症监护和术中失血量是肝移植术后早期死亡的两个独立危险因素。结论 争取在肝病发展至重症监护依赖期以前进行肝移植手术是降低肝移植术后早期死亡率的关键。同时 ,移植手术要精细 。

Objective To discuss the risk factors influencing early mortality after liver transplantation.Methods 53 adult patients underwent liver transplantation in our hospital from August 2000 to December 2002.They were divided into two groups:the dead group and the sruvival group.Preoperative and intraopierative clinical or laboratory data were collected.A univariate analysis was performed for the commonly used variables,then a logistic regression analysis was carried out with variables that achieved a significant level of <0.05 in the univariate analysis.Result Child class,preoperative intensive care,hepatic encephalopathy,extrahepatic infection,white blood cell count,total serum bilirubin,operative duration,operative blood loss,intraoperative blood transfusion and total fluid perfusion were of significance in the univariate analysis( P <0.05).A logistic regression analysis demonstrated that preoperative intensive care and operative blood loss were two independent risk factors that influence early mortality.Conclusion Performing liver transplantation before ICU bound period is the key to reduce the early mortality.In the mean time,the doctors should do the operation accurately and try to decrease the operative blood loss.