【摘要】 目的对肝移植术后腹腔积液并发症进行原因分析,了解其危险因素,从而指导肝移植术后腹腔积液的预防和治疗。方法回顾性分析2015年1月至2016年12月中山市人民医院47例肝移植患者临床资料,根据术后腹腔积液发生情况,分为腹腔积液组(24例)和无腹腔积液组(23例),采用单因素分析、Logistic多元回归分析以及ROC曲线分析肝移植术后发生腹腔积液的危险因素以及敏感度、特异度。结果 Logistic回归分析显示,术后第1天白蛋白(ALB)水平、供体胆碱酯酶(ChE)、脑死亡时间是肝移植术后腹腔积液的危险因素(P=0.017、0.044、0.035)。术后第1天ALB水平每增加评分一级、供体ChE每增加1 U、脑死亡时间增加1 h,患者术后腹腔积液风险分别增加6.531、1.000、1.052倍。ROC曲线分析发现,供体ChE的最佳截断值为5 142 U/L,判断术后腹腔积液发生风险敏感度为79.2%,特异度为56.5%,曲线下面积为0.676(P=0.039,95% CI:0.520～0.832);供体脑死亡时间截断值为21.5 h,判断术后腹腔积液发生风险敏感度为62.5%,特异度为73.9%,曲线下面积为0.674(P=0.041,95% CI:0.520～0.828)。结论提高术后第1天ALB水平,选择相对低ChE水平供体及减少供体脑死亡后等待时间可降低肝移植术后腹腔积液发生风险。更多还原

【Abstract】 Objective To analyze the reasons of ascites after liver transplantation and to understand the risk factors,so as to effectively prevent and treat ascites after liver transplantation.Methods A retrospective analysis of clinical data of forty-seven patients with liver transplantation from January 2015 to December 2016 in Zhongshan People’s Hospital were processed.According to the occurrence of ascites after operation,24 cases were divided into ascites group and 23 cases for non-ascites group.The risk factors of ascites after liver transplantation were analyzed by single factor analysis,Logistic regression analysis and ROC curve analysis.Results Logistic regression analysis showed that albumin (ALB) level at the first day after surgery,donor cholinesterase (ChE) and time after brain death were risk factors for ascites (P=0.017,0.044,0.035).The risk of ascites increased by 6.531,1.000 and 1.052 times for each grade of ALB at the first day after operation,1 U of donor ChE and 1 hour of time after brain death.ROC curve analysis showed that the optimal cut-off value of ChE was 5 142 U/L (P=0.039,95% CI:0.520-0.832),and the sensitivity and specificity were 79.2% and 56.5% respectively;the optimal cut-off value of time after brain death was 21.5 h (P=0.041,95% CI:0.520-0.828),and the sensitivity and specificity were 62.5% and 73.9% respectively.Conclusion Increasing the ALB level at the first day after surgery,choosing relatively low ChE donors and reducing the waiting time after brain death can reduce the risk of ascites after liver transplantation.更多还原