术后血小板计数低对术中未输注血小板的成人肝移植

Effect of low postoperative platelet count on early fatality rate of adult liver transplantation without platelet transfusion during operation

    摘要
  • 摘要:
      目的  探讨在肝移植受者术中未输注血小板（PLT）的情况下，术后早期PLT计数低对受者早期病死率的影响。
      方法  回顾性分析接受同种异体原位肝移植的180例受者临床资料。采用受试者工作特征（ROC）曲线计算术后7 d PLT计数预测术后早期病死率的临界值。根据临界值将受者分为低PLT计数组和对照组。纳入肝移植受者的相关临床资料，包括围手术期PLT计数、术前一般情况、术中情况。采用Logistic回归分析影响肝移植受者术后早期病死率的独立危险因素。观察并比较两组肝移植受者的早期预后情况，包括术后重症监护室（ICU）住院时间、术后住院时间、初期移植肝功能异常率、术后30 d病死率。
      结果  术后7 d PLT计数 < 32×109/L是肝移植受者术后30 d病死率的独立危险因素（P < 0.05）。低PLT计数组受者的术后ICU住院时间为9（5，14）d，明显长于对照组受者的5（3，6）d（P < 0.05）；初期移植肝功能异常率为55.0%，明显高于对照组受者的20.6%（P < 0.05）；术后30 d病死率为40.0%，明显高于对照组受者的2.5%（P < 0.05）。两组受者间的术后住院时间差异无统计学意义（P > 0.05）。
      结论  术后7 d PLT计数 < 32×109/L是肝移植受者术后30 d病死率的独立危险因素，其可以提示术后初期移植肝功能异常，辅助预测肝移植受者早期预后。

     

    Abstract:
      Objective  To investigate the effect of low platelet (PLT) count on the early fatality rate of liver transplant recipients without intraoperative PLT transfusion.
      Methods  Clinical data of 180 recipients undergoing orthotopic liver transplantation were retrospectively analyzed. The critical value of PLT count on postoperative 7 d to predict the early postoperative fatality rate was evaluated by the receiver operating characteristic(ROC) curve. All recipients were divided into the low PLT count group and control group according to the critical value. Relevant clinical data including perioperative PLT count, preoperative general conditions and intraoperative conditions of the recipients were included. The independent risk factors of the early fatality rate of liver transplant recipients were analyzed by Logistic regression analysis. The early prognosis of the recipients between two groups was observed and compared by the postoperative length of intensive care unit (ICU) stay, postoperative length of hospital stay, early allograft dysfunction and fatality rate on postoperative 30 d.
      Results  The PLT count < 32×109/L on 7 d after liver transplantation was an independent risk factor of the fatality rate on postoperative 30 d (P < 0.05). The postoperative length of ICU stay of the recipients in the low PLT count group was 9 (5, 14) d, significantly longer than 5 (3, 6) d in the control group (P < 0.05). In the low PLT count group, the early allograft dysfunction rate was 55.0%, significantly higher than 20.6% in the control group (P < 0.05). In the low PLT count group, the fatality rate on postoperative 30 d was 40.0%, significantly higher than 2.5% in the control group (P < 0.05). The length of hospital stay did not significantly differ between two groups (P > 0.05).
      Conclusions  The PLT count < 32×109/L on postoperative 7 d is an independent risk factor for the fatality rate on postoperative 30 d of liver transplant recipients. It can prompt the early allograft dysfunction and contribute to predict the early clinical prognosis of liver transplant recipients.

     

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