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MELD-Na评分对逆行灌注法原位肝移植术后早期急性肾损伤发生的预测作用

危国庆 程远 蔡秋程 杨芳 江艺

危国庆, 程远, 蔡秋程, 等. MELD-Na评分对逆行灌注法原位肝移植术后早期急性肾损伤发生的预测作用[J]. 器官移植, 2017, 8(5): 360-364. doi: 10.3969/j.issn.1674-7445.2017.05.005
引用本文: 危国庆, 程远, 蔡秋程, 等. MELD-Na评分对逆行灌注法原位肝移植术后早期急性肾损伤发生的预测作用[J]. 器官移植, 2017, 8(5): 360-364. doi: 10.3969/j.issn.1674-7445.2017.05.005
Wei Guoqing, Cheng Yuan, Cai Qiucheng, et al. Value of MELD-Na score for prediction of the incidence of acute kidney injury early after orthotopic liver transplantation using retrograde perfusion[J]. ORGAN TRANSPLANTATION, 2017, 8(5): 360-364. doi: 10.3969/j.issn.1674-7445.2017.05.005
Citation: Wei Guoqing, Cheng Yuan, Cai Qiucheng, et al. Value of MELD-Na score for prediction of the incidence of acute kidney injury early after orthotopic liver transplantation using retrograde perfusion[J]. ORGAN TRANSPLANTATION, 2017, 8(5): 360-364. doi: 10.3969/j.issn.1674-7445.2017.05.005

MELD-Na评分对逆行灌注法原位肝移植术后早期急性肾损伤发生的预测作用

doi: 10.3969/j.issn.1674-7445.2017.05.005
基金项目: 

福建省科技项目 2015Y0026

福建省自然科学基金科技项目 2016J01585

详细信息
    通讯作者:

    江艺, Email:jiangyi8183@163.com

  • 中图分类号: R617;R692

Value of MELD-Na score for prediction of the incidence of acute kidney injury early after orthotopic liver transplantation using retrograde perfusion

More Information
    Corresponding author: Jiang Yi, Email: jiangyi8183@163.com
  • 摘要:   目的  探讨术前终末期肝病模型联合血清钠(MELD-Na)评分对肝移植术后早期急性肾损伤(AKI)发生率的预测效果。  方法  回顾性分析315例行经下腔静脉逆行灌注法原位肝移植受者的临床资料。根据术前MELD-Na评分,将患者分为3组:A组为MELD-Na评分≤ 10分(115例);B组为10分<MELD-Na评分≤ 20分(118例);C组MELD-Na评分>20分(82例)。比较3组受者术前、术中各项指标。术前指标包括血清肌酐(Scr)、血尿素氮(BUN)、白蛋白(Alb)、总胆红素(TB)、凝血酶原时间国际标准化比值(PT-INR)、平均动脉压(MAP)、血清Na+等;术中指标包括手术时间、腔静脉阻断时间、出血量、输红细胞量、输血浆量、总补液量等。统计3组受者肝移植术后早期AKI的发生率及分期情况,并采用Spearman等级相关分析术前MELD-Na评分与AKI分期之间的关系。  结果  3组受者术前BUN、Alb、TB、PT-INR、MAP、Na+比较,差异均有统计学意义(均为P < 0.05),术中的腔静脉阻断时间、出血量、输红细胞量、输血浆量比较,差异亦均有统计学意义(均为P < 0.05)。315例肝移植受者,术后早期1周内AKI发生率64.8%(204/315),其中A、B、C组术后AKI发生率分别为43%(49/115)、71%(84/118)、87%(71/82),3组间比较差异有统计学意义(P < 0.05)。经Spearman等级相关分析,术前MELD-Na评分与AKI分期存在正相关(r=0.442,P=0.000)。  结论  MELD-Na评分不仅可以作为术前病情评估指标,也是术后发生AKI的重要预测指标。

     

  • 表  1  各组受者术前指标的比较

    Table  1.   Comparison of preoperative indicators of recipients among each group

    指标 A组(n=115) B组(n=118) C组(n=82) 统计值 P
    Scr(x±s,μmol/L) 68±15 65±18 69±20 02.03 00.13
    BUN(x±s,mmol/L) 4.4±1.2b 4.9±2.4b 6.7±3.6 22.97 < 0.05
    Alb(x±s,g/L) 38±7a, b 31±6 33±5 40.34 < 0.05
    TB[M(R),μmol/L] 15(6~41)a, b 35(8~44)b 316(26~925) 242.510 < 0.05
    PT-INR[M(R)] 1.07(0.83~1.40)a, b 1.40(0.81~2.64)b 2.11(1.10~20.27) 40.84 < 0.05
    MAP(x±s,mmHg) 82±16b 82±16b 77±15 03.49 < 0.05
    Na+(x±s,mmol/L) 140.1±2.6b 139.1±3.8b 133.7±6.4 57.07 < 0.05
    与B组比较,aP < 0.05;与C组比较,bP < 0.05;10 mmHg=1.33 kPa
    下载: 导出CSV

    表  2  各组受者术中指标的比较

    Table  2.   Comparison of intraoperative indicators of recipients among each group

    指标 A组(n=115) B组(n=118) C组(n=82) 统计值 P
    手术时间(x±s,h) 7.3±1.7 7.7±2.1 7.5±1.8 01.37 0.255
    腔静脉阻断时间(x±s,min) 45±7a, b 49±10 49±90 06.65 < 0.05
    出血量[M(R),mL] 2 000(500~8 000)a, b 3 000(500~28 000) 0b3 000(400~12 000) 33.76 < 0.05
    输红细胞量[M(R),mL] 001 200(0~8 800)a, b 002 000(0~9 400)b 00b02 800(0~10 000) 75.62 < 0.05
    输血浆量[M(R),mL] 00900(100~8 600)a, b 1 315(100~4 730)b 01 835(160~5 000)b 41.67 < 0.05
    总补液量[M(R),mL] 5 350(190~58 250) 05 640(500~15 750)b 5 425(1 120~12 500) 000.052 0.975
    与B组比较,aP < 0.05;与C组比较,bP < 0.05
    下载: 导出CSV

    表  3  各组受者术后AKI发生情况

    Table  3.   The incidence of postoperative AKI in each group [n(%)]

    组别 n AKI 1期 AKI 2期 AKI 3期 合计
    A组 115 40(35)0 7(6)0 2(2)0 49(43)0
    B组 118 42(36)0 27(23)0 15(13)0 84(71)0
    C组 082 30(37)0 19(23)0 22(27)0 71(87)0
    总计 315 112(35.6) 53(16.8) 39(12.4) 204(64.8)
    下载: 导出CSV
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出版历程
  • 收稿日期:  2017-06-30
  • 网络出版日期:  2021-01-19
  • 刊出日期:  2017-09-15

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