小儿肝移植术后急性肺损伤危险因素分析.docVIP

小儿活体肝移植术后急性肺损伤危险因素分析 陆秉玮 陈湧鸣 夏苏云 怀晓蓉 周姝婧 黄丹 张建军 夏强 王祥瑞 [摘要] 目的：回顾性分析小儿亲属间活体肝移植术（LRLT）后急性肺损伤的相关因素和独立危险因子。方法：回顾性分析2006年至2012年我院行LRLT患儿74例，根据术后发生急性肺损伤（ALI）情况分为ALI组（40例）与非ALI组（34例）。单因素分析ALI发生的相关危险因素，对所有P＜0.05因素进行二元Logistic回归分析ALI发生的独立危险因子。结果：74例患者中，术后发生ALI的患者共40例，ALI发生率为54.0%。单因素分析后得出：患者年龄≤12月、术前一月及一月以上有呼吸系统感染病史、术中输白蛋白量、术中每分钟每公斤体重出入量、机械通气时间＞24小时、再次行全麻手术、术前贫血、出院前末次总胆红素以及术前低K+共9项因素对LRLT后ALI发生有显著影响（P＜0.05）。经二元Logistic回归分析后得出，患者年龄≤12月、术前一月及一月以上有呼吸系统感染病史、术前中度及以上贫血（Hb＜90g/L），术前低K+（[K+]＜3.5mmol/L），术中输白蛋白量、术中每分钟每公斤体重出入量、机械通气时间＞24小时、再次行全麻手术均是ALI发生的独立危险因素。结论：年龄、术前一月及以上有呼吸系统感染病史、术前中、重度贫血、术前低钾。术中出入量及白蛋白使用量，术后机械通气时间、再次全麻手术与术后ALI密切相关。 关键词： 小儿亲属间活体肝移植 急性肺损伤 危险因素 围术期 Risk Factors of Acute Lung Injury After Pediatric Living Related Liver Transplantation *LU Bingwei，CHEN Yongming，XIA Suyun，HUAI Xiaorong，ZHOU Shujing，HUANG Dan，ZHANG Jianjun，XIA Qiang，Wang Xiangrui *Deportment of Anesthesiology，Renji Hospital，Shanghai Jiaotong University School of Medicine，Shanghai 200127，China. Corresponding author：WANG Xiangrui [Abstract] Objective To analyze the related factors and independent risk factors for acute lung injury(ALI) after pediatric living related liver transplantation by a retrospective survey.Methods Seventy-four patients undergoing LRLT were enrolled in this study. According to whether or not ALI developed posttransplantation，all patients were divided into ALI group and Non—ALI group．.Several statistically significant risk factors were screened out with univarite analysis，then independent risk factors were determined with binary logistic regression analysis． Results Of all the 74 patients，forty patiens got ALI.The morbidity of ALl was 54.0％.Univariate analysis showed that the occurrence of ALl was associated with age(≤12 months)，respiratory infection got a month or more before the surgery，anemia before surgery,low K+ concertration before surgery, the amount of intraoperative albumin consumption,per kilogram per minute intake and output volume，time o