肝移植术后急性肾损伤危险因素的临床研究

发布时间：2018-02-24 02:43

  本文关键词： 急性肾损伤 肝移植 危险因素　出处：《首都医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:回顾性分析肝移植患者术后发生急性肾损伤(AKI)高危因素及预后情况,为临床预防及治疗急性肾损伤提供理论依据。方法:回顾性收集2013年6月1日至2016年10月31日入住首都医科大学附属北京友谊医院重症医学科的所有肝移植患者,除外肝肾联合移植的患者、既往行肾移植的患者、二次肝移植患者、终末期肾病依赖透析患者、术前诊断AKI的患者。将所有入组的患者依据KDIGO标准分为急性肾损伤组和非急性肾损伤组,对成人和儿童患者进行分层分析。纳入分析的因素包括人口学特征,既往病史包括高血压、糖尿病病史,肝病分型,MELD评分。术前化验值指标:肌酐、白蛋白、总胆红素、ALT、AST。术中记录:手术时间、冷/热缺血时间、液体平衡。术后资料:ICU住院天数,总住院天数和28天死亡率。用单因素分析找出两组间有差别的变量,再用logistic回归分析筛选出发生急性肾损伤的危险因素,ROC曲线建立预测模型。结果:在纳入的279例肝移植术后患者中,成人(年龄≥18岁)124例,发生急性肾损伤的为68例,发生率为54.8%,在发生急性肾损伤患者中,根据KDIGO分期,I期患者45例,所占比例为66.2%;II期患者9例,所占比例为13.2%,III期患者14例,所占比例为20.6%;儿童(年龄18岁)155例,发生急性肾损伤的为38例,发生率24.5%,在发生急性肾损伤患者中,根据KDIGO分期,I期患者18例,所占比例为47.4%;II期患者14例,所占比例为36.8%,III期患者6例,所占比例为15.8%。logistic回归模型分析显示成人肝移植术后发生AKI的独立高危因素包括术中低血压时间(OR=1.020)、术中失血量(OR=1.036)和术中液体正平衡(OR=1.015),ROC曲线中其界值分别为27.5min、32.5ml/kg、31.2ml/kg,曲线下面积分别为0.662[p=0.002,95%可信区间(0.567,0.757)]、0.637[p=0.009,95%可信区间(0.540,0.734)]、0.624[p=0.017,95%可信区间(0.526,0.723)]。儿童肝移植术后发生AKI的危险因素包括术前PLT(OR=1.006),术前感染(OR=3.238),术中腔静脉阻断时间(OR=1.058),前者和后者ROC曲线中其界值分别为210×109/L、29.5min,三者曲线下面积分别为0.634[p=0.013,95%可信区间(0.526,0.741)]、0.657[p=0.004,95%可信区间(0.561,0.790)]、0.676[p=0.015,95%可信区间(0.561,0.790)]。结论:肝移植术后成人AKI发生率为54.8%;成人肝移植术后发生AKI的危险因素为术中低血压时间、术中失血量和术中液体正平衡;成人AKI组住院时间较非AKI组住院时间延长。肝移植术后儿童AKI发生率为24.5%;儿童发生AKI的危险因素为术前血小板、术中腔静脉阻断时间和术前感染;儿童AKI组28天死亡率较非AKI组增加。
[Abstract]:Objective: to analyze the risk factors and prognosis of acute renal injury (AKI) after liver transplantation. Methods: from June 1st 2013 to October 31st 2016, all the patients who were admitted to the Department of intensive Medicine of Beijing Friendship Hospital affiliated to Capital Medical University were collected retrospectively. Except for patients with combined liver and kidney transplantation, patients with previous kidney transplantation, patients with secondary liver transplantation, patients with end-stage nephropathy dependent on dialysis, The patients who diagnosed AKI before operation were divided into acute renal injury group and non-acute renal injury group according to KDIGO criteria. The previous history included hypertension, diabetes mellitus, liver classification and meld score. Preoperative laboratory parameters: creatinine, albumin, total bilirubin and alt AST.Intraoperative records: operation time, cold / hot ischemia time, fluid balance. Postoperative stay in ICU. Total hospitalization days and 28 days mortality rate. Single factor analysis was used to find out the difference between the two groups. Logistic regression analysis was used to screen out the risk factors of acute renal injury and to establish a predictive model. Results: among the 279 patients who underwent liver transplantation, 124 were adults (age 鈮，

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