【摘要】 目的探讨移植肝缺血-再灌注损伤程度的评估方法及其与肝移植患者预后的关系。方法218例良性终末期肝病患者,在移植肝恢复血液灌注后1 h采取外周静脉血,测定丙氨酸转氨酶浓度(定义为基础肝功能),同时采用组织气体分析仪测定肝组织的氧分压,并取肝组织活检,计算水变性及坏死细胞百分比,分别对上述3项指标进行评分,再根据各指标得分之和将缺血-再灌注损伤程度划分为5级(0～Ⅳ级),统计围手术期(术后2周内)、术后近期(术后2周至1个月)、术后中远期(1个月以上)的患者死亡率。结果移植肝缺血-再灌注损伤程度评为0级者157例(A组),死亡7例(4．5%),71．4%(5/7)死于术后3～6个月；缺血-再灌注损伤程度评为Ⅰ级者25例(B组),死亡5例(20．0%),80．0%(4/5)死于术后2周至3个月；缺血-再灌注损伤程度评为Ⅱ级者23例(C组),死亡5例(21．7%),80．0%(4/5)死于术后2周至3个月；缺血-再灌注损伤程度评为Ⅲ级者8例(D组),死亡7例(87．5%),85．7%(6/7)死于术后1个月内；缺血-再灌注损伤程度评为Ⅳ级者5例(E组),全部死亡,80．0%(4/5)死于术后1个月内。A组各期死亡率明显低于B组、C组(P＜0．05)和D组、E组(p＜0．01)；B组、C组间各期死亡率的差异无统计学意义(P＞0．05)；B组、C组各期死亡率均低于D组、E组(P＜0．05)。结论基础肝功能、组织氧分压以及水变性和坏死细胞百分比三项指标可基本反映移植肝缺血-再灌注损伤程度；缺血-再灌注损伤评级达Ⅲ～Ⅳ级者术后死亡率较高。更多还原

【Abstract】 Objective To approach a method to quickly evaluate the grade of ischemia- reperfusion injury of liver grafts and examine its impact on the prognosis of the patients after liver transplantation.Methods 218 patients suffering from benign end-stage liver diseases were subjected to liver transplantation.At first h after reperfusion of the liver grafts,the ALT levels of peripheral ve- nous blood (defined as the basic liver function),the liver tissue oxygen tension and the ratio of hy- dropic degenerating and necrotic hepatocytes (by a biopsy of the grafts) were all examined simultane- ously.The three indexes were scored respectively and the ischemia-reperfusion injury of liver grafts was set for 5 grades (0-Ⅳ) correspondingly according to the different total score.The mortality of pe- ri-operational stage (2 weeks after operation),early stage (2 weeks to 1 month) and late stage (1 month later) were calculated.Results Seven patients (4.5%) died in the 157 patients accepting the grade 0 ischemia-reperfusion injury of liver grafts (group A) and 71.4% (5/7) died during the 3rd to the 6th month after operations Five patients (20.0%) died in the 25 patients accepting the gradeⅠreperfusion injury of liver grafts (group B),and 80.0% (4/5) during the 2nd week to the 3rd month after operation;Five patients (21.7%) died in the 23 patients accepting the gradeⅡischemia-reper- fusion injury of liver graft (group C),and 80.0% (4/5) during the 2nd week to the 3rd month after operation;Seven patients (87.5%) died in the 8 patients accepting the gradeⅢischemia-reperfusion injury of liver graft (group D),and 85.7% (6/7) on the 1st week after operation;All patients (100.0%) died in the 5 patients accepting the gradeⅣischemia-reperfusion injury of liver graft (group E),and 80.0% (4/5) on the 1st week after operation.The mortality of every stage in group A was much lower than in groups B,C (P＜0.05) and groups D,E (P＜0.01).No significant diffe- rent was found in mortality of various stages between groups B and C (P＞0.05);and the mortality of every stage in groups B and C was significantly lower than in groups D and E (P＜0.05).Conclusion The total score of three indexes (basic liver function,tissue oxygen tension and the ratio of hydropic degenerating and necrotic hepatocytes),can generally reflect the grade of ischemia-reperfusion injury of liver grafts;The patients accepting the gradeⅢorⅣreperfusion injury of liver grafts have an higher mortality.更多还原