本文關(guān)鍵詞： 急性腎損傷 肝移植 危險因素　出處：《首都醫(yī)科大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:回顧性分析肝移植患者術(shù)后發(fā)生急性腎損傷(AKI)高危因素及預(yù)后情況,為臨床預(yù)防及治療急性腎損傷提供理論依據(jù)。方法:回顧性收集2013年6月1日至2016年10月31日入住首都醫(yī)科大學(xué)附屬北京友誼醫(yī)院重癥醫(yī)學(xué)科的所有肝移植患者,除外肝腎聯(lián)合移植的患者、既往行腎移植的患者、二次肝移植患者、終末期腎病依賴透析患者、術(shù)前診斷AKI的患者。將所有入組的患者依據(jù)KDIGO標(biāo)準(zhǔn)分為急性腎損傷組和非急性腎損傷組,對成人和兒童患者進(jìn)行分層分析。納入分析的因素包括人口學(xué)特征,既往病史包括高血壓、糖尿病病史,肝病分型,MELD評分。術(shù)前化驗(yàn)值指標(biāo):肌酐、白蛋白、總膽紅素、ALT、AST。術(shù)中記錄:手術(shù)時間、冷/熱缺血時間、液體平衡。術(shù)后資料:ICU住院天數(shù),總住院天數(shù)和28天死亡率。用單因素分析找出兩組間有差別的變量,再用logistic回歸分析篩選出發(fā)生急性腎損傷的危險因素,ROC曲線建立預(yù)測模型。結(jié)果:在納入的279例肝移植術(shù)后患者中,成人(年齡≥18歲)124例,發(fā)生急性腎損傷的為68例,發(fā)生率為54.8%,在發(fā)生急性腎損傷患者中,根據(jù)KDIGO分期,I期患者45例,所占比例為66.2%;II期患者9例,所占比例為13.2%,III期患者14例,所占比例為20.6%;兒童(年齡18歲)155例,發(fā)生急性腎損傷的為38例,發(fā)生率24.5%,在發(fā)生急性腎損傷患者中,根據(jù)KDIGO分期,I期患者18例,所占比例為47.4%;II期患者14例,所占比例為36.8%,III期患者6例,所占比例為15.8%。logistic回歸模型分析顯示成人肝移植術(shù)后發(fā)生AKI的獨(dú)立高危因素包括術(shù)中低血壓時間(OR=1.020)、術(shù)中失血量(OR=1.036)和術(shù)中液體正平衡(OR=1.015),ROC曲線中其界值分別為27.5min、32.5ml/kg、31.2ml/kg,曲線下面積分別為0.662[p=0.002,95%可信區(qū)間(0.567,0.757)]、0.637[p=0.009,95%可信區(qū)間(0.540,0.734)]、0.624[p=0.017,95%可信區(qū)間(0.526,0.723)]。兒童肝移植術(shù)后發(fā)生AKI的危險因素包括術(shù)前PLT(OR=1.006),術(shù)前感染(OR=3.238),術(shù)中腔靜脈阻斷時間(OR=1.058),前者和后者ROC曲線中其界值分別為210×109/L、29.5min,三者曲線下面積分別為0.634[p=0.013,95%可信區(qū)間(0.526,0.741)]、0.657[p=0.004,95%可信區(qū)間(0.561,0.790)]、0.676[p=0.015,95%可信區(qū)間(0.561,0.790)]。結(jié)論:肝移植術(shù)后成人AKI發(fā)生率為54.8%;成人肝移植術(shù)后發(fā)生AKI的危險因素為術(shù)中低血壓時間、術(shù)中失血量和術(shù)中液體正平衡;成人AKI組住院時間較非AKI組住院時間延長。肝移植術(shù)后兒童AKI發(fā)生率為24.5%;兒童發(fā)生AKI的危險因素為術(shù)前血小板、術(shù)中腔靜脈阻斷時間和術(shù)前感染;兒童AKI組28天死亡率較非AKI組增加。
[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，

本文編號：1528580