实用器官移植电子杂志

实用器官移植电子杂志 ›› 2014, Vol. 2 ›› Issue (4): 230-234.DOI: 10.3969/j.issn.2095-5332.2014.04.006

• 论著 • 上一篇    下一篇

胆红素对成人肝移植术后急性呼吸窘迫综合征的影响

赵蔚 1 ，Victor W. Xia2
  

  1. 1. 山东大学附属千佛山医院麻醉科，山东 济南 250014 ；
    2. 美国加州大学洛杉矶分校罗纳德 . 里根医疗中心麻醉科，美国 洛杉矶 90095-7403
  • 出版日期:2014-07-20 发布日期:2021-05-09

The impact of bilirubin for acute respiratory distress syndrome in post-liver transplantation adults

Zhao Wei1，Victor W. Xia2. 
  

  1. 1. Department of Anesthesiology，Shandong Provincial Qianfoshan Hospital，ShandongUniversity，Jinan 250014， Shandong，China  2. Department of Anesthesiology，Ronald Reagan UCLA MedicalCenter，David Geffen School of Medicine at UCLA，Los Angeles，
    CA 90095-7430，USA
  • Online:2014-07-20 Published:2021-05-09

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摘要：

目的 回顾性分析成人肝移植患者术后急性呼吸窘迫综合征（acute respiratory distresssyndrome，ARDS）的发生和临床危险因素，探讨胆红素对 ARDS 发病和预后的影响。方法 经医学伦理委员会同意，选择 2004 年 1 月 1 日至 2011 年 12 月 31 日的成人（年龄≥ 18 岁）肝移植患者，所有数据来自加州大学洛杉矶分校（UCLA）的移植数据中心。诊断标准采用 2011 年 ARDS 柏林新定义，将患者分为ARDS 组和非 ARDS（No-ARDS）组两组，均采用全身麻醉。分析数据包括一般情况，实验室检查如总胆红素、肌酐、电解质（K+、Na+）及预后情况。数据分析软件采用 IBM SPSS 20.0 软件。结果 1 335 例肝移植患者中有 57 例术后出现 ARDS，发生率为 4.3% ；终末期肝病模型（MELD）评分和术前是否已经气管内插管两组之间差异均有统计学意义（均 P ＜ 0.05）。电解质和肌酐两组间无明显差异（P ＞ 0.05）。总胆红素在术前〔（411.01±322.16）μmol/L 比（250.17±271.04）μmol/L〕和术后第 7 天〔（164.84±146.55）μmol/L比（84.13±91.83）μmol/L〕ARDS 组明显高于 No-ARDS 组（均 P ＜ 0.05）；经 logistic 分析，术前总胆红素≥ 324.9 μmol/L（P ＝ 0.013，95% CI ＝ 1.164 ～ 3.578）和术后第 7 天总胆红素≥ 188.1 μmol/L（P ＝ 0.001，95% CI ＝ 1.488 ～ 5.331）是 ARDS 发生的独立危险因素。ARDS 组 1 年病死率明显高于 No-ARDS 组（6.10%比 3.30%，P ＝ 0.033）。结论 ① 肝移植术后 ARDS 发生率为 4.3%，是多个因素作用的结果 ；② 胆红素对ARDS 的作用与剂量有关，术前总胆红素≥ 324.9 μmol/L、术后第 7 天总胆红素≥ 188.1 μmol/L 是术后 ARDS发生的危险因素。

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Abstract:

Objective To retrospectively analyze the incidence and risk factors of acute respiratorydistress syndrome（ARDS）in post-liver transplant adult patients, and to approach the effect of bilirubin onmorbidity and prognosis of ARDS. Methods After winninginstitutional review board approval，clinicaldata of adult patients（age ≥ 18 years）undergone liver transplantation from UCLA Transplant Database Centerbetween January 1st，2004 and December 31st，2011 were collected. Diagnosis of ARDS was determinedusing criteria proposed by the 2011 Berlin definition. All patients were underwent general anesthesia，andthey were divided into ARDS group and non-ARDS group（No-ARDS）. The general state and laboratoryexamination results including total bilirubin （TBil），creatinine （Cr），electrolyte （K+，Na+），and prognosiswere analyzed. Statistical analyses were performed using the IBM SPSS 20.0. Results Of 1 335 patientsundergone liver transplantation，57 cases（4.3%）occurred postoperative ARDS. Univariate analysis showedARDS was associated with significantly higher preoperative model for end-stage liver disease（MELD）scoreand requirement of endotracheal intubation（both P ＜ 0.05）. TBil in the ARDS group were significantly higher

than those in the No-ARDS group preoperatively〔（411.01±322.16）μmol/L vs.（250.17±271.04）μmol/L〕and the 7th day after liver transplantation〔（164.84±146.55）μmol/L vs.（84.13±91.83）μmol/L，both P ＜ 0.05〕.The Logistic analysis showed that TBil ≥ 324.9 μmol/L ahead of liver transplantation（P ＝ 0.013，95% CI ＝ 1.164-3.578）and TBIL ≥ 188.1 μmol/L on the 7th day after liver transplantation（P ＝ 0.001，95% CI ＝ 1.488-5.331）were independent risk factors for post transplant ARDS. One-year mortality in ARDSgroup was significantly higher than that in No-ARDS group（6.10% vs. 3.30%，P ＝ 0.033）. Conclusion① ARDS occurred at a rate of 4.3% in adult patients and were associated with poor post transplant outcomes ；② A higher concentration of bilirubin was associated with post-transplant ARDS. TBil ≥ 324.9 μmol/L ahead of livertransplantation and TBIL ≥ 188.1 μmol/L on the 7th day after liver transplantation were independent risk factors forpost-transplant ARDS.

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