發(fā)布時(shí)間：2018-06-22 13:37

  本文選題：DBCD + 肝移植��； 參考：《瀘州醫(yī)學(xué)院》2014年碩士論文

【摘要】：目的分析DBCD供體評(píng)估狀態(tài)與其肝腎移植受者術(shù)后器官功能恢復(fù)的相關(guān)性。方法回顧性分析2010年8月至2013年11月四川省人民醫(yī)院器官移植中心的12例DBCD供體評(píng)估資料及器官保護(hù)措施，供體相關(guān)資料包括：性別、年齡、腦死亡原因、既往疾病、ICU停留時(shí)間、器官熱缺血時(shí)間、血清肌酐濃度、ALT、AST、總膽紅素、白蛋白、維持收縮壓、維持舒張壓、白細(xì)胞計(jì)數(shù)、血紅蛋白、PT、APTT、FIB、INR、血糖值、血?dú)夥治鰌H值、血清K+濃度值、血清Na+濃度值，其中各指標(biāo)為入手術(shù)室前最后一次采集數(shù)據(jù)。以及由其提供器官的12例肝移植、22例腎移植的臨床資料。其中肝移植受者相關(guān)資料包括：性別、年齡、診斷、肝臟熱缺血時(shí)間、肝臟冷缺血時(shí)間、術(shù)后住院時(shí)間、術(shù)后7天ALT、術(shù)后14天ALT、術(shù)后21天ALT、術(shù)后7天總膽紅素、術(shù)后14天總膽紅素、術(shù)后21天總膽紅素、術(shù)后7天INR、術(shù)后14天INR、術(shù)后21天INR、術(shù)后ICU停留時(shí)間、術(shù)后呼吸機(jī)使用時(shí)間、術(shù)后白蛋白輸入量、術(shù)后新鮮血漿用量、術(shù)后紅懸輸入量；腎移植受者相關(guān)資料包括：性別、年齡、診斷、腎臟熱缺血時(shí)間、腎臟冷缺血時(shí)間、術(shù)后住院時(shí)間、術(shù)后3天肌酐值、術(shù)后7天肌酐值、術(shù)后14天肌酐值、出院時(shí)肌酐值、術(shù)后是否發(fā)生AR/DGF/肺部感染、術(shù)后透析次數(shù)。分析方法：將供體相應(yīng)數(shù)據(jù)分別與肝移植受者、腎移植受者術(shù)后恢復(fù)數(shù)據(jù)整理，以DBCD供體相關(guān)資料數(shù)據(jù)為因變量，肝腎移植受者術(shù)后恢復(fù)相關(guān)資料數(shù)據(jù)為自變量，對(duì)相關(guān)數(shù)據(jù)進(jìn)行“四性”檢查等初步審定后，擬建立相關(guān)性模型，運(yùn)用多重線性回歸或Logistic回歸分別分析兩組數(shù)據(jù)間的相關(guān)性，統(tǒng)計(jì)學(xué)處理經(jīng)SPSS19.0軟件操作完成，對(duì)能建立相關(guān)性模型且P＜0.05者認(rèn)為有統(tǒng)計(jì)學(xué)意義。結(jié)果本研究DBCD供體評(píng)估狀態(tài)各指標(biāo)中與其肝腎移植受者術(shù)后恢復(fù)相關(guān)性結(jié)果如下：1.肝移植受者術(shù)后發(fā)生原發(fā)無(wú)功能（PNF）1例(1/12,8.3%)，腎移植受者術(shù)后發(fā)生延遲功能恢復(fù)（DGF）11例(11/22,50%)。2.本研究中供體實(shí)施納入標(biāo)準(zhǔn)內(nèi)，供體熱缺血時(shí)間、冷缺血時(shí)間、血紅蛋白、FIB、白蛋白、肌酐，在本研究中，上述指標(biāo)未對(duì)其肝腎移植受者術(shù)后恢復(fù)造成影響。3.研究?jī)?nèi)供體指標(biāo)與其肝腎移植受者術(shù)后恢復(fù)有相關(guān)性統(tǒng)計(jì)學(xué)意義（P㩳0.05）的指標(biāo)：ICU停留時(shí)間、肝功（ALT/AST），維持收縮壓、凝血功能（PT/INR）、血糖，電解質(zhì)（Na+），本研究系統(tǒng)中，上述指標(biāo)能對(duì)其肝腎移植術(shù)后恢復(fù)可產(chǎn)生影響。4.年齡、腦死亡原因、維持舒張壓、APTT、動(dòng)脈血?dú)夥治鰌H值、總膽紅素、白細(xì)胞計(jì)數(shù)對(duì)其相應(yīng)肝腎移植術(shù)后恢復(fù)也存在相關(guān)性。結(jié)論1.DBCD供體經(jīng)積極采取相應(yīng)器官保護(hù)措施和正確評(píng)估，可成為適合我國(guó)國(guó)情的合理器官移植供體。2.本研究?jī)?nèi)。DBCD腎移植受者術(shù)后DGF發(fā)生率較高，，但經(jīng)透析等對(duì)癥處理后均能康復(fù)，供體術(shù)前尿量、肌酐等指標(biāo)的動(dòng)態(tài)監(jiān)測(cè)及控制于科學(xué)范圍對(duì)此有重要意義。3.本研究系統(tǒng)內(nèi)DBCD肝移植受者術(shù)后PNF發(fā)生率較低，可基本避免。4.DBCD供體評(píng)估各指標(biāo)中：熱缺血時(shí)間、冷缺血時(shí)間、血紅蛋白、FIB、白蛋白、肌酐范圍較最為固定，可調(diào)控性最小，此類(lèi)指標(biāo)在DBCD供體評(píng)估中最為重要。5.DBCD供體評(píng)估各指標(biāo)中：ICU停留時(shí)間、肝功（ALT/AST），維持收縮壓、凝血功能（PT/INR）、血糖，電解質(zhì)（K+、Na+）范圍較為固定，有一定可調(diào)控性，在DBCD供體評(píng)估中較為重要，應(yīng)動(dòng)態(tài)監(jiān)測(cè)并積極采取相應(yīng)器官保護(hù)措施控制在一定科學(xué)范圍內(nèi)，有利于相應(yīng)肝腎移植受者術(shù)后恢復(fù)。6.DBCD供體評(píng)估各指標(biāo)中：年齡、腦死亡原因、維持舒張壓、APTT、動(dòng)脈血?dú)夥治鰌H值、總膽紅素、白細(xì)胞計(jì)數(shù)范圍最為寬松，可調(diào)控程度較大，在DBCD供體評(píng)估中重要程度相對(duì)最低。
[Abstract]:Objective to analyze the correlation between the state of DBCD donor assessment and the recovery of organ function after hepatorenal transplantation. Methods a retrospective analysis of 12 cases of DBCD donor assessment and organ protection in the organ transplant center of Sichuan Provincial People's Hospital from August 2010 to November 2013 was conducted. The donor related data included sex, age, brain death, and previous diseases. Disease, ICU retention time, serum creatinine concentration, ALT, AST, total bilirubin, albumin, maintenance systolic pressure, maintenance diastolic pressure, leukocyte count, hemoglobin, PT, APTT, FIB, INR, blood glucose value, pH value of blood gas analysis, serum K+ concentration value, serum Na+ concentration, and the final data collected before entering the operation room. 12 cases of liver transplantation and 22 cases of renal transplantation, including sex, age, diagnosis, liver hot ischemia time, liver cold ischemia time, postoperative hospital time, 7 days after operation ALT, 14 days after operation, ALT 21 days after operation, 7 days after operation, total bilirubin, 14 days after operation, total bilirubin, and 21 days after operation. Bilirubin, 7 days after operation INR, 14 days after operation INR, 21 days after operation INR, postoperative ICU retention time, postoperative ventilation time, postoperative albumin input, postoperative fresh plasma dosage, postoperative red suspension input; renal transplantation recipients include: sex, age, diagnosis, kidney hot ischemia time, kidney cold ischemia time, postoperative hospitalization time, Creatinine value, creatinine value, creatinine value, creatinine value at 7 days after operation, creatinine value at 14 days after operation, creatinine value at the 14 day after operation, AR/DGF/ pulmonary infection and postoperative dialysis times. Analysis methods: the corresponding data of donor and liver transplantation recipients, renal transplant recipients were recovered after operation, and the data of DBCD donor related data were used as the dependent variables and liver and kidney transplantation received. After the initial examination of the related data, the correlation data was examined by "four sex" examination. The correlation model was established. The correlation between the two groups of data was analyzed by multiple linear regression or Logistic regression. The statistical processing was completed by SPSS19.0 software, and the correlation model could be established and P < 0.05 was recognized. The results were statistically significant. Results the correlation results of the DBCD donor assessment status and the postoperative recovery of liver and kidney transplantation recipients were as follows: 1. 1 cases of primary liver transplantation recipients had primary nonfunctional (1/12,8.3%) after operation (1/12,8.3%), and delayed function recovery (DGF) after renal transplantation (DGF) in 11 cases (11/22,50%).2. in this study, the donor implementation was included. Thermal ischemia time, cold ischemia time, hemoglobin, FIB, albumin, creatinine. In this study, the above indexes did not affect the postoperative recovery of.3. study in patients with liver and kidney transplantation, which were statistically significant (P? 0.05): ICU retention time, liver function (ALT/AST), Maintenance systolic pressure, blood coagulation function (PT/INR), blood glucose, and electrolyte (Na+). In this study system, the above indexes can affect the recovery of.4., the cause of brain death, the maintenance of diastolic pressure, the pH value of APTT, the arterial blood gas analysis, the total bilirubin, and the white blood cell count of the liver and kidney transplantation after the liver and kidney transplantation. Conclusion 1 The.DBCD donor has actively adopted the corresponding organ protection measures and correct evaluation, and can become a suitable organ transplant donor suitable for China's national conditions. In this study, the incidence of DGF in the.DBCD kidney transplant recipients was higher, but after dialysis and other symptomatic treatment, the dynamic monitoring and control of the indexes of the donor urine volume and creatinine were controlled and controlled by the scientific scope. It is of great significance that the incidence of PNF in DBCD liver transplantation recipients in this study system is low, which can basically avoid the indexes of.4.DBCD donor assessment: Hot ischemia time, cold ischemia time, hemoglobin, FIB, albumin, creatinine range is the most fixed, and the most important.5.DBCD donor in the DBCD donor evaluation. Among the indexes, ICU residence time, liver function (ALT/AST), systolic blood pressure, blood coagulation function (PT/INR), blood glucose and electrolyte (K+, Na+) are relatively fixed, and have certain regulability. It is more important in the evaluation of DBCD donor. It should be monitored dynamically and actively take the protective measures of the corresponding organs in a certain scientific range, which is beneficial to the corresponding liver and kidney movement. Among the recipients, the age, the cause of brain death, the maintenance of diastolic pressure, the APTT, the pH value of the arterial blood gas analysis, the total bilirubin, the total leucocyte count range were the most loose and the degree of regulation was relatively high, and the importance of the.6.DBCD donor was relatively low in the DBCD donor assessment.
【學(xué)位授予單位】：瀘州醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類(lèi)號(hào)】：R699.2;R657.3

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相關(guān)期刊論文 前1條

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本文編號(hào)：2053003