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原位肝移植再灌注后综合征出现心脏停搏的危险因素分析

王洋 曹经琳 高庆军 曾强 赵鑫 窦剑

王洋, 曹经琳, 高庆军, 等. 原位肝移植再灌注后综合征出现心脏停搏的危险因素分析[J]. 器官移植, 2014, 5(3): 169-173. doi: 10.3969/j.issn.1674-7445.2014.03.009
引用本文: 王洋, 曹经琳, 高庆军, 等. 原位肝移植再灌注后综合征出现心脏停搏的危险因素分析[J]. 器官移植, 2014, 5(3): 169-173. doi: 10.3969/j.issn.1674-7445.2014.03.009
Wang Yang, Cao Jinglin, Gao Qingjun, et al. Analysis of risk factors of developing cardiac arrest in postreperfusion syndrome of orthotopic liver transplantation[J]. ORGAN TRANSPLANTATION, 2014, 5(3): 169-173. doi: 10.3969/j.issn.1674-7445.2014.03.009
Citation: Wang Yang, Cao Jinglin, Gao Qingjun, et al. Analysis of risk factors of developing cardiac arrest in postreperfusion syndrome of orthotopic liver transplantation[J]. ORGAN TRANSPLANTATION, 2014, 5(3): 169-173. doi: 10.3969/j.issn.1674-7445.2014.03.009

原位肝移植再灌注后综合征出现心脏停搏的危险因素分析

doi: 10.3969/j.issn.1674-7445.2014.03.009
基金项目: 

河北省省级重大医学科研课题项目 zd2013031

详细信息
    通讯作者:

    窦剑, Email:j_douchina1114@qq.com

  • 中图分类号: R617

Analysis of risk factors of developing cardiac arrest in postreperfusion syndrome of orthotopic liver transplantation

  • 摘要:   目的  探讨原位肝移植再灌注后综合征(postreperfusion syndrome, PRS)中出现心脏停搏的危险因素。  方法  回顾性分析2003年至2013年在河北医科大学第三医院实施原位肝移植的192例患者的临床资料, 其中38例患者出现PRS。根据有否发生心脏停搏, 将38例PRS患者分为两组, 其中心脏停搏组患者7例, 男5例, 女2例; 非心脏停搏组患者31例, 男23例, 女8例。收集可能影响患者出现心脏停搏的指标, 包括性别、年龄、术前心脏指标(心电图或心脏彩色多普勒超声)、术前白蛋白、开放循环时(开放)临界pH值、临界体温、临界血钾、开放后血钙、供体脂肪肝情况、下腔静脉阻断时间及供肝冷缺血时间。两组间的数据比较采用t检验或Fisher精确概率检验。将两组比较差异有统计学意义的危险因素再进行非条件Logistic回归分析。  结果  PRS出现心脏停搏的可能危险因素包括开放临界pH值 < 7.35、开放临界体温 < 36℃、开放临界血钾>4 mmol/L和供肝中度脂肪肝(均为P < 0.05)。非条件Logistic回归分析结果表明, 供肝中度脂肪肝是PRS出现心脏停搏的独立危险因素。  结论  供肝中度脂肪肝是PRS出现心脏停搏的独立危险因素。合理选择供肝, 加强受体围手术期的处理, 这对降低心脏停搏的发生率有重要意义。

     

  • 表  1  两组再灌注后综合征患者的危险因素比较(计数资料)

    Table  1.   Comparison of risk factors of patients with postreperfusion syndrome between two groups (count data, n)

    组别n性别(女性)年龄(≥55岁)术前心脏指标(异常)术前白蛋白(<35 g/L)开放临界pH值(<7.35)开放临界体温(<36 ℃)开放临界血钾(>4 mmol/L)开放后血钙(<4 mmol/L)供肝中度脂肪肝
    心脏停搏组7254766575
    非心脏停搏组318138257107232
    P0.6080.1610.1240.2670.0040.0150.0220.1610.001
    下载: 导出CSV

    表  2  两组再灌注后综合征患者的危险因素比较(计量资料)

    Table  2.   Comparison of risk factors of patients with postreperfusion syndrome between two groups(measurement data, x±s)

    组别n下腔静脉阻断时间(min)供肝冷缺血时间(h)
    心脏停搏组778±217.9±2.3
    非心脏停搏组3177±207.8±2.2
    P0.8490.915
    下载: 导出CSV

    表  3  再灌注后综合征患者中发生心脏停搏的独立危险因素分析

    Table  3.   Analysis of independent risk factors of developing cardiac arrest in patients with postreperfusion syndrome

    相关因素βSEWaldχ2POR(95%可信区间)
    开放临界pH值<7.351.6602.5470.4250.5155.260(0.036~774.597)
    开放临界体温<36 ℃0.2022.6930.0060.9401.224(0.006~239.921)
    开放临界血钾>4 mmol/L-0.0171.9540.0000.9930.983(0.210~45.279)
    供肝中度脂肪肝2.5451.1974.5170.03412.738(1.219~133.126)
    注:β为偏回归系数;SE为偏回归系数的标准误;Wald χ2值为统计量
    下载: 导出CSV
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出版历程
  • 收稿日期:  2014-03-27
  • 网络出版日期:  2021-01-19
  • 刊出日期:  2014-05-15

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