中国实用外科杂志

中国实用外科杂志 ›› 2011, Vol. 31 ›› Issue (04): 325-327.

• 论著 • 上一篇    下一篇

24h乳酸清除率预测肝移植早期发生并发症临床价值研究

吴健锋，管向东，陈    娟，欧阳彬，陈敏英，黎丽芬，黄顺伟   

  1. 中山大学附属第一医院SICU，广东广州510080
  • 出版日期:2011-04-01 发布日期:2011-05-30

  • Online:2011-04-01 Published:2011-05-30

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摘要：

目的    探讨24h血乳酸清除率在肝移植早期并发症发生中的预测价值。方法    前瞻性观察并收集2007年1月至2009年12月中山大学附属第一医院肝移植术后进入外科重症监护病房172例病人的术前MELD评分、术前Child评分，入ICU24h后动脉血乳酸清除率及移植7d内病人发生的早期并发症。分别将病人分成早期并发症组和无早期并发症组，比较两组24h血乳酸清除率差异性。应用临床诊断性能（ROC）曲线，对乳酸清除率在预测肝移植术后发生感染中的应用价值进行评价。 结果    172例肝移植病人中有20.9%（36例）病人发生各种早期并发症。非并发症组、并发症组的早期乳酸清除率分别为（51.4±18.6）%和（17.3±11.2）%，差异有统计学意义（P<0.001）；早期乳酸清除率评价并发症发生ROC曲线You den指数最高时的24h血乳酸清除率截断值为34.5%，ROC曲线下面积为0.951±0.016（P<0.001），敏感性和特异性分别为95.3%和86.0%。结论    肝移植术后24h血乳酸清除率与肝移植后早期并发症发生率密切相关；24h血乳酸清除率＜34.5%是预测肝移植病人术后早期并发症发生的简易和准确的指标。

Abstract:

Twenty-four hours lactate clearance in prediction of early postoperative complications following liver transplantation        WU Jian-feng, GUAN Xiang-dong, CHEN Juan, et al. Department of SICU, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China
 Corresponding author: GUAN Xiang-dong, E-mail carlg @163.net
Abstract    Objective    To evaluate the clinical utility of 24h lactate clearance as predictor for early postoperative complications following liver transplantation. Methods    MELD score, Child score, 24h lactate clearance and early postoperative complications in 7 days of 172 patients admitted to SICU after liver transplantation between January 2007 and December 2009 in the First Affiliated Hospital of Sun Yat-sen University were collected and studied prospectively. All the patients were divided into non-complication group and complication group. The 24h lactate clearances between two groups were compared. Receiver operating characteristic (ROC) curves were plotted to measure the performance of the early lactate clearance. Results    Early complications occurred in 36 of overall 172 patients (20.9%). The 24h lactate clearance in non-complication group was significantly higher than that in complication group [(51.4±18.6)% vs (17.3±11.2)%, P<0.001]. The optimum cut-off value for 24h lactate clearance predicting early complications was 34.5% (sensitivity 95.3%, specificity 86.0%). The area under the curve of the ROC was 0.951±0.016（P<0.001）. Conclusion The 24h lactate clearance could serve as a prompt and accurate bedside predictor for early postoperative complications after liver transplantation. Patients with 24h lactate clearance less than 34.5% are associated with higher incidence of early postoperative complications.

Key words: liver transplantation, early complication, lactate clearance