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目的回顾性分析小儿亲属间活体肝移植术(LRLT)后急性肺损伤(ALI)的危险因素。方法 2006年10月—2012年4月在上海交通大学医学院附属仁济医院行LRLT的患儿74例,术后发生ALI(ALI组)40例(54.1%),未发生ALI(非ALI组)34例(45.9%)。将单因素分析筛选出的危险因素进行二元Logistic分析。结果单因素分析显示,ALI组年龄≤12个月、术前1个月前有呼吸系统感染史、机械通气时间>24h、再次开腹手术的构成比,术中静脉输注白蛋白总量、术中单位时间每公斤体重出入量(简称出入量)和出院前总胆红素(TBil)水平均显著高于非ALI组(P值均<0.05),术前血钾、血红蛋白(Hb)水平均显著低于非ALI组(P值均<0.01)。二元Logistic回归分析显示,年龄≤12个月(β=-1.39,OR=0.25,95%CI为0.09～0.69)、术前1个月前有呼吸系统感染史(β=1.90,OR=6.66,95%CI为1.89～23.50)、术前Hb水平<90g/L(中、重度贫血,β=1.22,OR=3.40,95%CI为1.27～9.08),术前血钾水平<3.5mmol/L(低钾血症,β=1.45,OR=4.26,95%CI为1.51～12.03)、静脉输注白蛋白总量(β=0.05,OR=1.50,95%CI为1.01～2.11)、术中出入量(β=4.40,OR=81.4,95%CI为1.31～5 017.50)、机械通气时间>24h(β=1.28,OR=3.60,95%CI为1.36～9.51)、再次行开腹手术(β=1.67,OR=5.33,95%CI为1.10～26.40)均是ALI发生的独立危险因素(P值分别<0.05、0.01)。结论年龄≤12个月,术前1个月前有呼吸系统感染史,术前中、重度贫血,术前低钾血症,术中出入量和静脉注射白蛋白总量,术后机械通气时间>24h,以及再次开腹手术是LRLT术后ALI发生的危险因素。
Objective To retrospectively analyze the risk factors of acute lung injury (ALI) after pediatric living donor liver transplantation (LRLT). Methods From October 2006 to April 2012, 74 children with LRLT in Renji Hospital Affiliated to Shanghai Jiao Tong University School of Medicine were enrolled. ALI (ALI group) 40 (54.1%) and ALI ) 34 cases (45.9%). The univariate analysis of screening risk factors for binary Logistic analysis. Results The univariate analysis showed that the ALI group had a history of respiratory infection less than 12 months and a month prior to surgery, the duration of mechanical ventilation was> 24 hours, the constituent ratio of reoperation, the intraoperative intravenous infusion of albumin, Intraoperative per kilogram of body weight during the entry and exit (referred to as the amount) and discharge before the total bilirubin (TBil) were significantly higher than non-ALI group (P all <0.05), preoperative serum potassium, hemoglobin (Hb) Were significantly lower than non-ALI group (P <0.01). Binary logistic regression analysis showed that the patients had a history of respiratory infection one month before surgery (β = 1.90, OR = 6.66, P = 1.39, OR = 0.25, 95% CI 0.09 to 0.69) , 95% CI 1.89 ~ 23.50), preoperative Hb level <90g / L (moderate and severe anemia, β = 1.22, OR = 3.40, 95% CI 1.27 ~ 9.08), preoperative serum potassium level <3.5mmol / (Hypokalemia, β = 1.45, OR = 4.26, 95% CI: 1.51-12.03), total albumin infusion (β = 0.05, OR = 1.50, 95% CI 1.01 ~ 2.11) (Β = 4.40, OR = 81.4, 95% CI 1.31 ~ 5 017.50), mechanical ventilation time 24h (β = 1.28, OR = 3.60, 95% CI 1.36 ~ 9.51) (β = 1.67, OR = 5.33, 95% CI 1.10 ~ 26.40) were all independent risk factors for ALI (P <0.05, 0.01 respectively). Conclusions Age ≤12 months, history of respiratory infection 1 month before surgery, preoperative and severe anemia, preoperative hypokalemia, intraoperative and intraoperative intravenous injection of albumin, the total amount of postoperative mechanical ventilation > 24h, and reoperation is a risk factor for ALI after LRLT.