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目的总结重型肝炎肝移植术后急性肾功能衰竭(ARF)的防治经验。方法回顾性分析2002年9月至2004年10月上海交通大学医学院附属瑞金医院因重型肝炎行肝移植治疗的37例病人的临床资料。结果37例病人术后1年移植物存活率为83.8%,围手术期死亡6例(16.2%),术后并发ARF12例(32.4%),ARF组与非ARF组术前血总胆红素、肌酐、腹水量、凝血酶原时间比较,差异有显著性意义;两组术中出血量、血制品输入量、无肝期、手术时间比较,差异亦有显著性意义。结论重型肝炎肝移植术后ARF诱发因素众多,多数病人经过综合治疗后肾功能能够得到恢复,必要时可选择连续性肾替代治疗(CRRT)。
Objective To summarize the prevention and treatment of acute renal failure (ARF) after liver transplantation in patients with severe hepatitis. Methods The clinical data of 37 patients who underwent liver transplantation for severe hepatitis were retrospectively analyzed from September 2002 to October 2004 at Ruijin Hospital Affiliated to Shanghai Jiaotong University School of Medicine. Results The survival rate of one year after operation was 83.8% in 37 cases, 6 cases (16.2%) in perioperative period, 12 cases (32.4%) in ARF group and non-ARF group. Preoperative blood total bilirubin , Creatinine, ascites, prothrombin time, the difference was significant; two groups of intraoperative blood loss, blood products input, anhepatic period, the operative time, the difference is also significant. Conclusions There are many ARF-induced factors after liver transplantation in patients with severe hepatitis. Renal function can be recovered in most patients after comprehensive treatment. If necessary, continuous renal replacement therapy (CRRT) can be selected.