原位肝移植再灌注后综合征出现心脏停搏的危险因素分析

摘要

目的：探讨原位肝移植再灌注后综合征（ postreperfusion syndrome ， PRS）中出现心脏停搏的危险因素。方法回顾性分析2003年至2013年在河北医科大学第三医院实施原位肝移植的192例患者的临床资料，其中38例患者出现PRS。根据有否发生心脏停搏，将38例PRS患者分为两组，其中心脏停搏组患者7例，男5例，女2例；非心脏停搏组患者31例，男23例，女8例。收集可能影响患者出现心脏停搏的指标，包括性别、年龄、术前心脏指标（心电图或心脏彩色多普勒超声）、术前白蛋白、开放循环时（开放）临界pH值、临界体温、临界血钾、开放后血钙、供体脂肪肝情况、下腔静脉阻断时间及供肝冷缺血时间。两组间的数据比较采用t检验或Fisher精确概率检验。将两组比较差异有统计学意义的危险因素再进行非条件Logistic回归分析。结果 PRS出现心脏停搏的可能危险因素包括开放临界pH值＜7.35、开放临界体温＜36℃、开放临界血钾＞4 mmol/L和供肝中度脂肪肝（均为P＜0.05）。非条件Logistic回归分析结果表明，供肝中度脂肪肝是PRS出现心脏停搏的独立危险因素。结论供肝中度脂肪肝是PRS出现心脏停搏的独立危险因素。合理选择供肝，加强受体围手术期的处理，这对降低心脏停搏的发生率有重要意义。%Objective To investigate the risk factors of developing cardiac arrest in postreperfusion syndrome ( PRS) of orthotopic liver transplantation ( OLT ).Methods Clinical data of 192 patients who underwent OLT in the Third Hospital of Hebei Medical University from 2003 to 2013 were retrospectively analyzed.Among them, 38 patients developed PRS.According to the occurrence of cardiac arrest or not , the patients were divided into 2 groups, including 7 cases in cardiac arrest group (5 males and 2 females) and 31 cases in non-cardiac arrest group (23 males and 8 females).The probable influence factors of cardiac arrest were selected, including gender, age, preoperative cardiac indexes ( electrocardiogram or color doppler ultrasound of heart ) , preoperative albumin , borderline pH value during opening circulation , borderline temperature, borderline blood potassium level , blood calcium level after opening , degree of donor fatty liver , time of occluding inferior vena cava , and cold ischemia time of donor liver.Comparison of data between two groups was used t-test or Fisher exact probability test.Rick factors with significance differences between two groups were analyzed by unconditional Logistic regression analysis.Results Probable risk factors of developing cardiac arrest in PRS included borderline pH value <7.35 during opening circulation , borderline temperature<36 ℃during opening circulation , borderline blood potassium level >4 mmol/L during opening circulation and moderate fatty liver ( all in P<0.05 ).Results of unconditional Logistic regression analysis showed that moderate fatty liver was an independent risk factor of cardiac arrest in PRS.Conclusions Moderate fatty liver is an independent risk factor of cardiac arrest in PRS.The rational application of liver donors and paying more attention to perioperative treatment of recipients have important significance for reducing the incidence of cardiac arrest.