【摘要】 目的探讨术前并存腹水或低钠血症对不同MELD评分患者在肝移植手术中输血量和升压药应用的影响。方法192例行肝移植手术患者,按术前MELD评分、有无腹水或低钠血症分组,记录并比较肝移植手术中浓缩红细胞,冰冻血浆的输入量及升压药使用情况。结果高MELD(>30)评分组与低MELD(≤30)评分组比较,在手术中需输入更多的血液和使用升压药维持循环平稳;不同血清钠组(Na<130 mmol/L,Na≥130 mmol/L)在手术中输血量和升压药使用情况无明显差异;而并存腹水的患者,不论MELD评分及MELD+A高低,与非腹水组相比,在手术中均需输入更多的血液和更高的升压药使用率。结论虽然腹水和低钠血症均是衡量肝脏疾病严重性的指标,但仅有腹水这一指标影响患者在肝移植手术中的循环平稳。更多还原

【Abstract】 Objective To investigate whether hyponatremia and/or ascites were associated with any changes in the amount of transfusion and vasopress or requirements during orthotopic liver transplantation(OLT).Methods Medical records of 192 OLT patients were retrospectively reviewed.Intraoperative transfusion of red blood cells(RBC) or fresh frozen plasma(FFP) and administration of vasopressors were compared.Results Patients with high MELD score were associated with higher requirements for intraoperative transfusion and vasopressors than those with low MELD score.Patients with or without hyponatremia(Na<130 mmol/L) had similar requirements for transfusion and vasopressors.Patients with ascites had significantly higher requirements for both transfusion and vasopressors compared with those without ascites(P<0.01).Patients with high MELD plus ascites scores had higher requirements for transfusion and vasopressors compared with patients with low MELD+A scores(P<0.01).Conclusion Ascites,but not hyponatremia,is associated with increased intraoperative transfusion and vasopressor requirements during OLT although both hyponatremia and ascites are indicators of liver disease severity.更多还原