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目的探讨肝移植术后脑出血可能的危险因素。方法回顾性分析中国广州中山大学第一和第三附属医院从1996年5月至2005年4月收治的454例肝移植患者的临床资料,病例组入选标准:(1)行尸肝供体原位肝移植病人;(2)术后出现脑出血;(3)所有病例均经头颅CT或MRI检查明确诊断;(4)术前有过脑出血病史者不能入选。其中脑出血病例组12人,年龄为(56.33±10.25)岁。无脑出血对照组48例,年龄为(50.38±10.20)岁。调查内容包括:(1)共同因素:性别,年龄,术前诊断、乙肝表面抗原、乙肝病毒脱氧核糖核酸(HBVDNA)、肝功能Child分级、凝血四项、血常规、肝功能、电解质、是否入住重症监护室(1CU)、血压及中心静脉压,手术时间,冷缺血时间,无肝期,术中出血量,术后血常规、凝血四项、血压及中心静脉压、感染情况(以培养出细菌、真菌为标准)。(2)脑出血患者另外收集:脑出血前血压、中心静脉压,脑出血时间,脑出血部位(以CT描述为准),脑出血后手术与否,预后状况。所有数据应用SPSS12.0 for windows统计学软件包进行统计学分析。首先应用单因素相关分析,筛选出两组有显著差异的参数,然后再对这些参数进行多元回归分析,从中找出肝移植术后并发脑出血的独立危险因素。结果单因素相关分析显示两组间术前人住ICU、术前肝功能Child分级、术前血红蛋白(HB)、术前活化部分凝血活酶时间(AFTT)、术前白蛋白(ALB)、术中出血量、手术时间、术后血小板(PLT)、术后活化部分凝血活酶时间(APIT)等差异有统计学意义(P<0.05)。多元回归分析显示术前肝功能Child分级情况和术中出血量是肝移植术后并发脑出血的两个独立危险因素(P<0.05)。结论术前肝功能Child C级和术中出血量可能对预测肝移植术后脑出血具有重要价值。
Objective To investigate the possible risk factors of cerebral hemorrhage after liver transplantation. Methods The clinical data of 454 patients with liver transplantation who were admitted to the First and Third Affiliated Hospital of Sun Yat-sen University in Guangzhou from May 1996 to April 2005 were retrospectively analyzed. The selection criteria of the patients were: (1) Patients with liver transplantation; (2) postoperative cerebral hemorrhage; (3) all cases were diagnosed by head CT or MRI; (4) preoperative cerebral hemorrhage history can not be enrolled. Including cerebral hemorrhage cases in 12 patients, age (56.33 ± 10.25) years old. No cerebral hemorrhage control group of 48 patients, age (50.38 ± 10.20) years. The survey included: (1) common factors: gender, age, preoperative diagnosis, hepatitis B surface antigen, hepatitis B virus DNA (HBVDNA), liver function Child classification, coagulation four, blood, liver function, electrolytes, Intensive care unit (ICU), blood pressure and central venous pressure, operation time, cold ischemia time, anhepatic phase, intraoperative blood loss, postoperative blood, clotting four, blood pressure and central venous pressure, infection Bacteria, fungi as the standard). (2) Patients with ICH were collected separately: prehypertensive blood pressure, central venous pressure, intracerebral hemorrhage time, cerebral hemorrhage site (based on CT description), postoperative intracerebral hemorrhage or prognosis. All data were statistically analyzed using SPSS12.0 for windows statistical software package. Firstly, single factor correlation analysis was used to screen out significant differences between the two groups of parameters, and then multiple regression analysis of these parameters to find out the independent risk factors for intracranial hemorrhage after liver transplantation. Results Univariate correlation analysis showed that preoperative ICU, Preoperative liver function Child classification, preoperative hemoglobin (HB), preoperative activation partial thromboplastin time (AFTT), preoperative albumin (ALB), surgery The amount of bleeding, operation time, postoperative PLT and postoperative APT were significantly different (P <0.05). Multivariate regression analysis showed that Child classification of preoperative liver function and intraoperative blood loss were two independent risk factors for cerebral hemorrhage after liver transplantation (P <0.05). Conclusion Preoperative liver function Child C grade and intraoperative blood loss may be of great value in predicting cerebral hemorrhage after liver transplantation.