超声引导下移植肝穿刺活检术后出血的危险因素分析

摘要

目的：探讨超声引导下移植肝穿刺活组织检查（活检）出血的危险因素。方法回顾性分析2013年2月至2015年4月在中山大学附属第三医院行超声引导下肝穿刺活检的51例肝移植患者的临床资料。以穿刺术后出血作为应变量，将患者年龄、性别、凝血功能、活检时间、活检次数、活检组织条数、是否使用抗凝药物及患者能否配合呼吸屏气作为自变量，对所有自变量进行多因素非条件 Logistic 回归分析，筛选出与超声引导下移植肝穿刺活检出血相关的危险因素。结果51例肝移植患者共穿刺活检84次，术后出血5例（6％）。多因素非条件 Logistic 回归分析显示有明显出血倾向、使用抗凝药物及呼吸配合欠佳是肝穿刺活检出血的独立危险因素（OR 分别为8.71、3.16、2.03，均为 P ＜0.05）。结论有明显出血倾向、使用抗凝药物及呼吸配合欠佳是超声引导下移植肝穿刺活检出血的危险因素。%Objective To investigate the risk factors of hemorrhage after ultrasound-guided liver graft biopsy.Methods Clinical data of 51 liver transplant patients undergoing ultrasound-guided liver graft biopsy in the Third Affiliated Hospital,Sun Yat-sen University between February 201 3 and April 201 4 were retrospectively studied.Hemorrhage after biopsy was taken the dependent variable.Age,gender,coagulation, duration of biopsy,frequency of biopsy,number of biopsy tissues,medication of anticoagulant or not and cooperation in breathing and breath holding or not were taken as the independent variables.Multivariate non-conditional Logistic regression analysis was performed for all independent variables to screen out the risk factors associated with hemorrhage after ultrasound-guided liver graft biopsy.Results Fifty-one patients underwent 84 biopsies in total and 5 cases (6%)had hemorrhage after biopsy.The multivariate non-conditional Logistic regression analysis showed that obvious hemorrhagic tendency,medication of anticoagulant and poor cooperation in breathing were independent risk factors of hemorrhage after liver graft biopsy (OR was respectively 8.71 , 3.1 6 and 2.03,all in P <0.05).Conclusions Obvious hemorrhagic tendency,medication of anticoagulant and poor cooperation in breathing are independent risk factors of hemorrhage after ultrasound-guided liver graft biopsy.