Xia V W, Fond A, Du B
Department of Anesthesiology, David Geffen School of Medicine, UCLA, Los Angeles, California 90095-1778, USA, and 2nd Affiliated Hospital, Kunming, China.
Transplant Proc. 2006 Jun;38(5):1398-9. doi: 10.1016/j.transproceed.2006.02.107.
We previously demonstrated that patients with high MELD scores required significantly higher volumes of blood transfusion and vasopressor usage during orthotopic liver transplantation (OLT) compared with patients with low MELD scores. Now we investigated whether hyponatremia or ascites were associated with increased transfusion and vasopressor requirements during OLT.
Medical records of 192 OLT patients between January 1, 2004, and May 5, 2005, were retrospectively reviewed. Intraoperative transfusion of red blood cells (RBC) or fresh frozen plasma (FFP) and administration of vasopressors were compared.
As expected, patients with high (>30) MELD scores were associated with higher requirements for intraoperative transfusion and vasopressors than those with low (<or=30) MELD scores. Patients with or without hyponatremia (Na+> or <or=130) had similar requirements for transfusion and vasopressors. Patients with ascites had significantly higher requirements for both transfusion and vasopressors compared with those without (16.6+/-9.6 versus 11.8+/-9.0 for RBC; 22.0+/-11.0 versus 16.1+/-11.8 for FFP; and 60.2% versus 37.5% for vasopressors, P=.001 to .002). Patients with high (>30) MELD plus ascites scores (MELD+A, 4.5 points added to MELD if ascites was present) had higher requirements for transfusion and vasopressors compared with patients with low (<or=30) MELD+A scores (16.1+/-9.9 versus 11.4+/-8.6 for RBC; 21.7+/-12.7 versus 15.2+/- 9.6; and 63.4% versus 28.2% for vasopressors, P=.001 to <.001).
Although hyponatremia and ascites are indicators for liver disease severity, ascites, but not hyponatremia, is associated with increased intraoperative transfusion and vasopressor requirements during OLT.
我们之前证明，与低终末期肝病模型（MELD）评分的患者相比，高MELD评分的患者在原位肝移植（OLT）期间需要显著更多的输血和血管升压药。现在我们研究低钠血症或腹水是否与OLT期间输血和血管升压药需求增加有关。
回顾性分析2004年1月1日至2005年5月5日期间192例OLT患者的病历。比较术中红细胞（RBC）或新鲜冰冻血浆（FFP）的输注情况以及血管升压药的使用情况。
正如预期的那样，与低（≤30）MELD评分的患者相比，高（>30）MELD评分的患者术中输血和血管升压药的需求更高。有或无低钠血症（Na+>或≤130）的患者输血和血管升压药的需求相似。与无腹水的患者相比，有腹水的患者输血和血管升压药的需求显著更高（RBC：16.6±9.6对11.8±9.0；FFP：22.0±11.0对16.1±11.8；血管升压药：60.2%对37.5%，P = 0.001至0.002）。高（>30）MELD加腹水评分（MELD+A，如果存在腹水则MELD增加4.5分）的患者与低（≤30）MELD+A评分的患者相比，输血和血管升压药的需求更高（RBC：16.1±9.9对11.4±8.6；FFP：21.7±12.7对15.2±9.6；血管升压药：63.4%对28.2%，P = 0.001至<0.001）。
虽然低钠血症和腹水是肝病严重程度的指标，但腹水而非低钠血症与OLT期间术中输血和血管升压药需求增加有关。
