DBCD供体评估及器官保护与其肝肾移植受者术后器官功能恢复的相关性分析

发布时间：2018-06-22 13:37

本文选题：DBCD + 肝移植　；参考：《泸州医学院》2014年硕士论文

【摘要】：目的分析DBCD供体评估状态与其肝肾移植受者术后器官功能恢复的相关性。方法回顾性分析2010年8月至2013年11月四川省人民医院器官移植中心的12例DBCD供体评估资料及器官保护措施，供体相关资料包括：性别、年龄、脑死亡原因、既往疾病、ICU停留时间、器官热缺血时间、血清肌酐浓度、ALT、AST、总胆红素、白蛋白、维持收缩压、维持舒张压、白细胞计数、血红蛋白、PT、APTT、FIB、INR、血糖值、血气分析pH值、血清K+浓度值、血清Na+浓度值，其中各指标为入手术室前最后一次采集数据。以及由其提供器官的12例肝移植、22例肾移植的临床资料。其中肝移植受者相关资料包括：性别、年龄、诊断、肝脏热缺血时间、肝脏冷缺血时间、术后住院时间、术后7天ALT、术后14天ALT、术后21天ALT、术后7天总胆红素、术后14天总胆红素、术后21天总胆红素、术后7天INR、术后14天INR、术后21天INR、术后ICU停留时间、术后呼吸机使用时间、术后白蛋白输入量、术后新鲜血浆用量、术后红悬输入量；肾移植受者相关资料包括：性别、年龄、诊断、肾脏热缺血时间、肾脏冷缺血时间、术后住院时间、术后3天肌酐值、术后7天肌酐值、术后14天肌酐值、出院时肌酐值、术后是否发生AR/DGF/肺部感染、术后透析次数。分析方法：将供体相应数据分别与肝移植受者、肾移植受者术后恢复数据整理，以DBCD供体相关资料数据为因变量，肝肾移植受者术后恢复相关资料数据为自变量，对相关数据进行“四性”检查等初步审定后，拟建立相关性模型，运用多重线性回归或Logistic回归分别分析两组数据间的相关性，统计学处理经SPSS19.0软件操作完成，对能建立相关性模型且P＜0.05者认为有统计学意义。结果本研究DBCD供体评估状态各指标中与其肝肾移植受者术后恢复相关性结果如下：1.肝移植受者术后发生原发无功能（PNF）1例(1/12,8.3%)，肾移植受者术后发生延迟功能恢复（DGF）11例(11/22,50%)。2.本研究中供体实施纳入标准内，供体热缺血时间、冷缺血时间、血红蛋白、FIB、白蛋白、肌酐，在本研究中，上述指标未对其肝肾移植受者术后恢复造成影响。3.研究内供体指标与其肝肾移植受者术后恢复有相关性统计学意义（P㩳0.05）的指标：ICU停留时间、肝功（ALT/AST），维持收缩压、凝血功能（PT/INR）、血糖，电解质（Na+），本研究系统中，上述指标能对其肝肾移植术后恢复可产生影响。4.年龄、脑死亡原因、维持舒张压、APTT、动脉血气分析pH值、总胆红素、白细胞计数对其相应肝肾移植术后恢复也存在相关性。结论1.DBCD供体经积极采取相应器官保护措施和正确评估，可成为适合我国国情的合理器官移植供体。2.本研究内。DBCD肾移植受者术后DGF发生率较高，，但经透析等对症处理后均能康复，供体术前尿量、肌酐等指标的动态监测及控制于科学范围对此有重要意义。3.本研究系统内DBCD肝移植受者术后PNF发生率较低，可基本避免。4.DBCD供体评估各指标中：热缺血时间、冷缺血时间、血红蛋白、FIB、白蛋白、肌酐范围较最为固定，可调控性最小，此类指标在DBCD供体评估中最为重要。5.DBCD供体评估各指标中：ICU停留时间、肝功（ALT/AST），维持收缩压、凝血功能（PT/INR）、血糖，电解质（K+、Na+）范围较为固定，有一定可调控性，在DBCD供体评估中较为重要，应动态监测并积极采取相应器官保护措施控制在一定科学范围内，有利于相应肝肾移植受者术后恢复。6.DBCD供体评估各指标中：年龄、脑死亡原因、维持舒张压、APTT、动脉血气分析pH值、总胆红素、白细胞计数范围最为宽松，可调控程度较大，在DBCD供体评估中重要程度相对最低。
[Abstract]:Objective to analyze the correlation between the state of DBCD donor assessment and the recovery of organ function after hepatorenal transplantation. Methods a retrospective analysis of 12 cases of DBCD donor assessment and organ protection in the organ transplant center of Sichuan Provincial People's Hospital from August 2010 to November 2013 was conducted. The donor related data included sex, age, brain death, and previous diseases. Disease, ICU retention time, serum creatinine concentration, ALT, AST, total bilirubin, albumin, maintenance systolic pressure, maintenance diastolic pressure, leukocyte count, hemoglobin, PT, APTT, FIB, INR, blood glucose value, pH value of blood gas analysis, serum K+ concentration value, serum Na+ concentration, and the final data collected before entering the operation room. 12 cases of liver transplantation and 22 cases of renal transplantation, including sex, age, diagnosis, liver hot ischemia time, liver cold ischemia time, postoperative hospital time, 7 days after operation ALT, 14 days after operation, ALT 21 days after operation, 7 days after operation, total bilirubin, 14 days after operation, total bilirubin, and 21 days after operation. Bilirubin, 7 days after operation INR, 14 days after operation INR, 21 days after operation INR, postoperative ICU retention time, postoperative ventilation time, postoperative albumin input, postoperative fresh plasma dosage, postoperative red suspension input; renal transplantation recipients include: sex, age, diagnosis, kidney hot ischemia time, kidney cold ischemia time, postoperative hospitalization time, Creatinine value, creatinine value, creatinine value, creatinine value at 7 days after operation, creatinine value at 14 days after operation, creatinine value at the 14 day after operation, AR/DGF/ pulmonary infection and postoperative dialysis times. Analysis methods: the corresponding data of donor and liver transplantation recipients, renal transplant recipients were recovered after operation, and the data of DBCD donor related data were used as the dependent variables and liver and kidney transplantation received. After the initial examination of the related data, the correlation data was examined by "four sex" examination. The correlation model was established. The correlation between the two groups of data was analyzed by multiple linear regression or Logistic regression. The statistical processing was completed by SPSS19.0 software, and the correlation model could be established and P < 0.05 was recognized. The results were statistically significant. Results the correlation results of the DBCD donor assessment status and the postoperative recovery of liver and kidney transplantation recipients were as follows: 1. 1 cases of primary liver transplantation recipients had primary nonfunctional (1/12,8.3%) after operation (1/12,8.3%), and delayed function recovery (DGF) after renal transplantation (DGF) in 11 cases (11/22,50%).2. in this study, the donor implementation was included. Thermal ischemia time, cold ischemia time, hemoglobin, FIB, albumin, creatinine. In this study, the above indexes did not affect the postoperative recovery of.3. study in patients with liver and kidney transplantation, which were statistically significant (P? 0.05): ICU retention time, liver function (ALT/AST), Maintenance systolic pressure, blood coagulation function (PT/INR), blood glucose, and electrolyte (Na+). In this study system, the above indexes can affect the recovery of.4., the cause of brain death, the maintenance of diastolic pressure, the pH value of APTT, the arterial blood gas analysis, the total bilirubin, and the white blood cell count of the liver and kidney transplantation after the liver and kidney transplantation. Conclusion 1 The.DBCD donor has actively adopted the corresponding organ protection measures and correct evaluation, and can become a suitable organ transplant donor suitable for China's national conditions. In this study, the incidence of DGF in the.DBCD kidney transplant recipients was higher, but after dialysis and other symptomatic treatment, the dynamic monitoring and control of the indexes of the donor urine volume and creatinine were controlled and controlled by the scientific scope. It is of great significance that the incidence of PNF in DBCD liver transplantation recipients in this study system is low, which can basically avoid the indexes of.4.DBCD donor assessment: Hot ischemia time, cold ischemia time, hemoglobin, FIB, albumin, creatinine range is the most fixed, and the most important.5.DBCD donor in the DBCD donor evaluation. Among the indexes, ICU residence time, liver function (ALT/AST), systolic blood pressure, blood coagulation function (PT/INR), blood glucose and electrolyte (K+, Na+) are relatively fixed, and have certain regulability. It is more important in the evaluation of DBCD donor. It should be monitored dynamically and actively take the protective measures of the corresponding organs in a certain scientific range, which is beneficial to the corresponding liver and kidney movement. Among the recipients, the age, the cause of brain death, the maintenance of diastolic pressure, the APTT, the pH value of the arterial blood gas analysis, the total bilirubin, the total leucocyte count range were the most loose and the degree of regulation was relatively high, and the importance of the.6.DBCD donor was relatively low in the DBCD donor assessment.
【学位授予单位】：泸州医学院
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R699.2;R657.3

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