本文選題：DBCD + 肝移植　； 參考：《瀘州醫(yī)學院》2014年碩士論文

【摘要】：目的分析DBCD供體評估狀態(tài)與其肝腎移植受者術后器官功能恢復的相關性。方法回顧性分析2010年8月至2013年11月四川省人民醫(yī)院器官移植中心的12例DBCD供體評估資料及器官保護措施，供體相關資料包括：性別、年齡、腦死亡原因、既往疾病、ICU停留時間、器官熱缺血時間、血清肌酐濃度、ALT、AST、總膽紅素、白蛋白、維持收縮壓、維持舒張壓、白細胞計數(shù)、血紅蛋白、PT、APTT、FIB、INR、血糖值、血氣分析pH值、血清K+濃度值、血清Na+濃度值，其中各指標為入手術室前最后一次采集數(shù)據(jù)。以及由其提供器官的12例肝移植、22例腎移植的臨床資料。其中肝移植受者相關資料包括：性別、年齡、診斷、肝臟熱缺血時間、肝臟冷缺血時間、術后住院時間、術后7天ALT、術后14天ALT、術后21天ALT、術后7天總膽紅素、術后14天總膽紅素、術后21天總膽紅素、術后7天INR、術后14天INR、術后21天INR、術后ICU停留時間、術后呼吸機使用時間、術后白蛋白輸入量、術后新鮮血漿用量、術后紅懸輸入量；腎移植受者相關資料包括：性別、年齡、診斷、腎臟熱缺血時間、腎臟冷缺血時間、術后住院時間、術后3天肌酐值、術后7天肌酐值、術后14天肌酐值、出院時肌酐值、術后是否發(fā)生AR/DGF/肺部感染、術后透析次數(shù)。分析方法：將供體相應數(shù)據(jù)分別與肝移植受者、腎移植受者術后恢復數(shù)據(jù)整理，以DBCD供體相關資料數(shù)據(jù)為因變量，肝腎移植受者術后恢復相關資料數(shù)據(jù)為自變量，對相關數(shù)據(jù)進行“四性”檢查等初步審定后，擬建立相關性模型，運用多重線性回歸或Logistic回歸分別分析兩組數(shù)據(jù)間的相關性，統(tǒng)計學處理經(jīng)SPSS19.0軟件操作完成，對能建立相關性模型且P＜0.05者認為有統(tǒng)計學意義。結(jié)果本研究DBCD供體評估狀態(tài)各指標中與其肝腎移植受者術后恢復相關性結(jié)果如下：1.肝移植受者術后發(fā)生原發(fā)無功能（PNF）1例(1/12,8.3%)，腎移植受者術后發(fā)生延遲功能恢復（DGF）11例(11/22,50%)。2.本研究中供體實施納入標準內(nèi)，供體熱缺血時間、冷缺血時間、血紅蛋白、FIB、白蛋白、肌酐，在本研究中，上述指標未對其肝腎移植受者術后恢復造成影響。3.研究內(nèi)供體指標與其肝腎移植受者術后恢復有相關性統(tǒng)計學意義（P㩳0.05）的指標：ICU停留時間、肝功（ALT/AST），維持收縮壓、凝血功能（PT/INR）、血糖，電解質(zhì)（Na+），本研究系統(tǒng)中，上述指標能對其肝腎移植術后恢復可產(chǎn)生影響。4.年齡、腦死亡原因、維持舒張壓、APTT、動脈血氣分析pH值、總膽紅素、白細胞計數(shù)對其相應肝腎移植術后恢復也存在相關性。結(jié)論1.DBCD供體經(jīng)積極采取相應器官保護措施和正確評估，可成為適合我國國情的合理器官移植供體。2.本研究內(nèi)。DBCD腎移植受者術后DGF發(fā)生率較高，，但經(jīng)透析等對癥處理后均能康復，供體術前尿量、肌酐等指標的動態(tài)監(jiān)測及控制于科學范圍對此有重要意義。3.本研究系統(tǒng)內(nèi)DBCD肝移植受者術后PNF發(fā)生率較低，可基本避免。4.DBCD供體評估各指標中：熱缺血時間、冷缺血時間、血紅蛋白、FIB、白蛋白、肌酐范圍較最為固定，可調(diào)控性最小，此類指標在DBCD供體評估中最為重要。5.DBCD供體評估各指標中：ICU停留時間、肝功（ALT/AST），維持收縮壓、凝血功能（PT/INR）、血糖，電解質(zhì)（K+、Na+）范圍較為固定，有一定可調(diào)控性，在DBCD供體評估中較為重要，應動態(tài)監(jiān)測并積極采取相應器官保護措施控制在一定科學范圍內(nèi)，有利于相應肝腎移植受者術后恢復。6.DBCD供體評估各指標中：年齡、腦死亡原因、維持舒張壓、APTT、動脈血氣分析pH值、總膽紅素、白細胞計數(shù)范圍最為寬松，可調(diào)控程度較大，在DBCD供體評估中重要程度相對最低。
[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.
【學位授予單位】：瀘州醫(yī)學院
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R699.2;R657.3

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相關期刊論文 前1條

1 魏亞非;劉永光;陳樺;郭穎;李留洋;范禮佩;岳良升;李民;趙明;;國際標準化心臟死亡捐獻腎移植受者的預后分析[J];廣東醫(yī)學;2011年24期

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