【作者】 霍永忠；

【导师】 李波；

【作者基本信息】 四川大学 ， 外科学， 2005， 硕士

【摘要】 目的:观察供肝冷缺血时间与肝移植病人术后近期预后的关系,为临床供肝的保存提供依据;分析供肝血型对肝移植术后病人预后的影响,为临床供肝的选择提供依据。 方法:按照循证医学的思想,回顾性调查收集四川大学华西医院肝移植中心2003年1月至2005年2月肝移植住院完整病历128例资料,纳入文献上所有对肝移植术后影响的单因素指标(包括一些动物试验指标和临床指标)以确立移植预后影响因素;采用单因素分析方法排除对肝移植近期预后影响不相关的因素;应用logistic回归模型确定肝移植近期预后的影响因素。 结果:(1)在单因素T检验分析中,冷缺血时间与肝移植病人术后近期预后有统计学意义(P=0.032、95%CI为1.000～1.004),多因素统计结果显示与患者预后密切相关(P=0.063),提示供肝冷缺血时间与肝移植术后病人预后有关。将冷缺血时间分段后与TB、AST做单因素直线回归,结果显示随着冷缺血时间的延长,患者术后总胆红素(total bilirubin,TB)、丙氨酸基转移酶(alanine aminotransferase,ALT)下降减慢,供肝冷缺血时更多还原

【Abstract】 Objective: Analyze the dependablity between cold ischemia reperfusion injury and early mortality following liver transplantation, which presenting theoretical basis of conserving donator liver; Analyze impact that ABO compatible and inconformity make early mortality following liver transplantation different, and present the choice of donator liver from theory.Methods: According to the idea of based-evidence medical, this study adopted retrospective review 128 cases in Sichuan University West China Hospital of liver transplantation center from 2003.1 to 2005.2. and bring into all index of influencing postoperative liver transplantation from literatures, animal experiment and clinic included; Adopt univariate analysis to exclude from non- dependability or less dependability factors of influencing early mortality following liver transplantation; Apply Losgistic regression model to analyze the dependality of all factor to early mortality following liver transplantation; from professional viewResults: (1) The univariate analysis of T test shows that relationship between cold ischemia time and early mortality following liver transplantation has statistic significance (P=0.032, 95% CI is 1.000-1.004). The result of multiple factor analysis show that the relationship between cold ischemia time and is closely-related (P=0.063), which indicate cold ischemia time is related to early mortality following liver transplantation. We analysis the relationship section of old ischemia time, TB and AST by linear regression model, which show that with the increase of cold ischemia time, the decline of TB and AST of postoperative patients slow. If cold ischemia time is within 600 minutes, the decline of postoperative patients TB is faster. If cold ischemia time is over 900 minutes, the decline of postoperative patients TB is slower. This indicates that cold ischemia time will lead to the delay of liver function recovery of postoperative patients following liver transplantation.(2) 24.8% (26/105) of patients which blood type of donor and recipient are compatible have rejection reactions. 78.3 %(18/23) of patients which blood type of donor and recipient are matching but incompatible have rejection reactions. The statistic analyses also indicate that blood type being compatible but not matching has little influence on the prognosis to the liver transplant patients in the near future.Conclusions: Cold ischemia time is close-related to patient’s near-team prognostic. Blood type compatibility will lead to the increase of acute rejection but not Increase mortality in short time after liver transplantation更多还原