肝移植术后早期肺部并发症的危险因素分析及预防.doc

肝移植术后早期的危险因素分析及预防 ，周杰南方医科大学南方医院肝胆外科，广州，510515摘要目的　探讨肝移植术后早期的危险因素，为临床防治提供参考和依据。方法　回顾性分析本院施行的1例肝移植。选取围手术期个独立变量进行单因素分析及Logistic回归分析，筛选出与肝移植术后早期相关的危险因素。结果　例发生，为.6%。Logistic回归分析结果术前、ICU留观时间≥53 d 至少有2 d 的液体平衡≤- 500 mL具有统计学意义。结论　多种因素可以导致肝移植术后早期，有效控制相关因素降低发生率。关键词肝移植危险因素Analysis and prophylaxis of the risk factors for pulmonary complication following liver transplantation Tian Yu-wei, Zhou Jie, Wang Yu,Lin Yi-xiong, Tan Yong-fa, Zheng Zhi-peng, Tang Bin.Department of Hepatobiliary Surgery, Nanfang Hospital, Southern Medical University, Guangzhou510515, China. ［Abstract］Objective To deternine the risk factors and the clinical findings correlated with pulmonary complication during early postoperative period after liver transplantation. Methods 154 cases of liver transplantation performeed in the five and a half years in Nanfang Hospital were studied retrospectively. Twenty-two independent variables were analyzed by univariate analysis and logistic regression to screen out the risk factors. Results pulmonary complication occurred in 98 cases（.6%）.Logistic regression analysis showed that pre-operative hypoproteinemia, the total amount of blood products—transfusion4L,observation in ICU more than 5 days, fluid balance(≤ 一500 m1) in≥2 days of the first 3 days after operation are significances. Conclusion Because multiple risk factors can lead to respiratory Complications following liver transplantation, it’s important to make effective control of these factors to reduce the incidence of pulmonary complication. [Key words] Liver transplantation; Pulmonary complication; Risk factor Corresponding author :Zhou Jie Tel；86-02e-mail:jacky@ 肝移植术后早期以肺部并发症最常见，而肺部并发症则是影响肝移植术后患者早期生存率的主要原因之一[1, 2]。研究肝移植术后早期的相关危险因素，对具有重要意义。笔者对2004年8月～2009年月我院施行的例原位肝脏移植手术的临床资料进行回顾性分析，以寻找与术后早期相关的危险因素，并提出预防措施。 1 1.1 一般资料 本组男例，女例。平均年龄4.5（16～74）岁，平均住院时间62.9（16～），平均ICU)留观时间3.8（1～19）d。原发病包括肝炎后肝硬化例，原发性肝癌例，重症肝炎例，布加综合征1例，肝豆状核变性1例。 1.2 术式与免疫抑制方案 经典例，背驮式例。免疫抑制剂方案：术后常规采用三联抗排斥治疗（FK506）、、甲基强松龙5d后改为FK506、、强地松F