高钠血症供体对肝移植受体围手术期肝功能的影响

Effect of hypernatremia in donors on perioperative liver function of recipients undergoing liver transplantation

    摘要
  • 摘要:
      目的  探讨高钠血症供体对肝移植受体围手术期肝功能恢复的影响。
      方法  回顾性分析73例肝移植受体资料。根据供体血清钠离子水平将受体分为高钠血症组（供体血清钠≥150 mmol/L，19例）与非高钠血症组（供体血清钠 < 150 mmol/L，54例）。对受体术后1、3、7、14、21 d的血清丙氨酸转氨酶（ALT）、天冬氨酸转氨酶（AST）、终末期肝病模型（MELD）评分、白蛋白、总胆红素（TB）、血清肌酐、凝血酶原时间、肝细胞生长因子（HGF）进行检测，对受体术后护肝药使用时间、重症监护室（ICU）住院时间、平均住院时间及并发症发生率进行比较分析。
      结果  与非高钠血症组相比，高钠血症组受体术后1、3、7 d的血清TB、ALT、AST、HGF水平和MELD评分显著升高（均为P < 0.05），而血清白蛋白水平明显降低（均为P < 0.05）。高钠血症组受体术后3、7 d的凝血酶原时间明显长于非高钠血症组（均为P < 0.05）。高钠血症组的受体术后护肝药使用时间和ICU住院时间分别为9（7~13）、11（8~13）d，明显长于非高钠血症组的4（3~9）、7（3~9）d（均为P < 0.05）。两组受体术后平均住院时间、血清肌酐水平、并发症发生率的比较，差异无统计学意义（均为P>0.05）。所有受体均康复出院。
      结论  供体获取前高钠血症对受体围手术期肝功能并无明显影响，但会延长受体术后肝功能的恢复时间。

     

    Abstract:
      Objective  To evaluate the effect of hypernatremia in donors on perioperative recovery of liver function in the recipients undergoing liver transplantation.
      Methods  Clinical data of 73 liver transplant recipients were analyzed retrospectively. According to the serum levels of sodium in donors, all recipients were divided into hypernatremia group (donor serum sodium ≥150 mmol/L, n=19) and non-hypernatremia group (donor serum sodium < 150 mmol/L, n=54). Serum alanine aminotransferase(ALT), aspartate aminotransferase (AST), model for end-stage liver disease (MELD) score, albumin, total bilirubin (TB), serum creatinine, prothrombin time and hepatocyte growth factor (HGF) in the recipients were detected at 1, 3, 7, 14 and 21 d after liver transplantation. The time of postoperative use of liver-protecting drugs in the recipients, the length of intensive care unit (ICU) stay, the average length of hospital stay and the incidence rate of postoperative complications were statistically compared and analyzed.
      Results  Compared with the non-hypernatremia group, the serum levels of TB, ALT, AST, HGF and MELD scores of the recipients in the hypernatremia group at the postoperative 1, 3 and 7 d were significantly higher (all P < 0.05), whereas the serum albumin level was significantly decreased (P < 0.05). The prothrombin time in the hypernatremia group was significantly longer than that in the non-hypernatremia group at 3 and 7 d after operation (both P < 0.05). In the hypernatremia group, the time of postoperative use of liver-protecting drugs and the length of ICU stay were 9 (7-13) d and 11 (8-13) d, significantly longer than 4 (3-9) d and 7 (3-9) d in the non-hypernatremia group (both P < 0.05). The average length of hospital stay, serum creatinine level and incidence rate of postoperative complications did not significantly differ between two groups (all P>0.05). All recipients were recovered and discharged.
      Conclusions  The hypernatremia in donors exert no significant effect on the perioperative liver function of the recipients, whereas it can prolong the postoperative recovery time of liver function of the recipients.

     

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