【摘要】：目的:總結(jié)分析心臟死亡(DCD)供肝肝移植術(shù)后早期移植物功能不全(EAD)的相關(guān)危險(xiǎn)因素,建立EAD預(yù)警列線圖模型,并開展DCD供肝肝移植受者預(yù)后評(píng)判研究。方法:回顧性分析2010年1月至2015年12月浙江大學(xué)醫(yī)學(xué)院附屬第一醫(yī)院完成的323例DCD供肝肝移植病人的臨床資料。觀察肝移植受者早期移植物功能恢復(fù)情況,分析影響EAD發(fā)生的相關(guān)危險(xiǎn)因素,建立EAD預(yù)警列線圖模型,COX比例風(fēng)險(xiǎn)回歸方法對(duì)影響移植物存活率的相關(guān)危險(xiǎn)因素進(jìn)行分析。結(jié)果:單因素分析發(fā)現(xiàn)供肝大泡性脂肪變性比例≥20%等10個(gè)危險(xiǎn)因素,多因素進(jìn)一步研究發(fā)現(xiàn)供肝大泡性脂肪變性比例≥20%(P=0.021)、供者血鈉(P0.001)、供者BMI(P=0.010)、受者術(shù)前MELD評(píng)分(P=0.030)是DCD供肝肝移植術(shù)后EAD發(fā)生的獨(dú)立危險(xiǎn)因素,基于上述危險(xiǎn)因素建立預(yù)測(cè)EAD發(fā)生的列線圖模型,C-inedx為0.707。COX比例風(fēng)險(xiǎn)回歸分析發(fā)現(xiàn)EAD(P=0.015)、供者年齡(P=0.006)、術(shù)中失血量(P0.001)顯著影響術(shù)后移植物存活率。結(jié)論:EAD是影響DCD供肝肝移植術(shù)后移植物存活率的重要危險(xiǎn)因素,列線圖模型可方便有效預(yù)測(cè)肝移植術(shù)后EAD的發(fā)生,指導(dǎo)臨床醫(yī)生科學(xué)評(píng)估和安全使用不同風(fēng)險(xiǎn)供肝。明確EAD發(fā)生的相關(guān)危險(xiǎn)因素并及早采取干預(yù)措施是提高肝移植受者生存的關(guān)鍵。
[Abstract]:Objective: to summarize and analyze the risk factors of early graft insufficiency (EAD) after cardiac death (DCD) donor liver transplantation, to establish a EAD early warning line graph model and to evaluate the prognosis of DCD donor liver transplantation recipients. Methods: the clinical data of 323 DCD donor liver transplantation patients from January 2010 to December 2015 in the first affiliated Hospital of Zhejiang University Medical College were retrospectively analyzed. To observe the recovery of graft function in the early stage of liver transplantation, to analyze the related risk factors affecting the occurrence of EAD, to establish the EAD early-warning line graph model, and to analyze the related risk factors affecting the survival rate of grafts by COX proportional risk regression method. Results: ten risk factors, such as the proportion of donor liver vesicular steatosis 鈮，

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