探讨术中去甲肾上腺素用量＋术前终末期肝病模型联合血清钠(MELD-Na评分)＋术中总入量标准(以下简称"NMF标准")在肝移植术后急性肾损伤(AKI)患者肾脏替代治疗(RRT)时机选择中的临床应用价值。

回顾性分析2018年1月至2023年6月宁波大学附属李惠利医院ICU收治的肝移植术后并发AKI患者临床资料，根据前期研究结果制订NMF标准，将173例患者分为4组：(1)A组(n＝41)，符合NMF标准，且在收治ICU<6 h内行RRT；(2)B组(n＝55)，符合NMF标准，但未行RRT或收治ICU≥6 h后行RRT；(3)C组(n＝18)，不符合NMF标准，但在收治ICU<6 h内行RRT；(4)D组(n＝59)，不符合NMF标准，且未行RRT或收治ICU≥6 h后行RRT。分析比较患者一般资料：年龄、性别、体质指数、病因、序贯器官衰竭评估评分、急性生理和慢性健康状况评价Ⅱ评分、移植手术时间、手术方式、是否伴肝昏迷；临床指标：移植术前、术后以及术后第3、7天血清肌酐、MELD-Na评分、血氨；预后指标：累计机械通气时间、累计ICU停留时间、总住院时间，患者28、90 d和1年死亡率，是否并发导管相关血流感染(CRBSI)、慢性肾脏病(CKD)和肝功能异常，是否需长期RRT。正态分布计量资料组间比较采用t检验，非正态分布计量资料组间比较采用Mann-Whitney U检验，计数资料组间比较采用χ²检验或Fisher确切概率法。P<0.05为差异具有统计学意义。

A组和B组患者术后第3、7天血清肌酐和血氨以及术后第7天MELD-Na评分差异均有统计学意义(U/t＝2.24、5.30、7.37、7.55和2.73，P均<0.05)。C组和D组患者术后第3天血清肌酐、血氨差异均有统计学意义(U＝2.21和5.20，P均<0.05)。A组和B组患者总住院时间以及气管切开、并发CKD和长期RRT比例差异均有统计学意义(t/χ²＝3.23、4.59和3.93，P均<0.05)。C组和D组患者并发CRBSI比例差异有统计学意义(P<0.05)。

按照NMF标准行RRT的肝移植术后AKI患者，其术后血清肌酐、MELD-Na评分和血氨改善更优，总住院时间缩短，并发CKD以及需长期RRT的比例更低；而不符合NMF标准但行RRT的患者，其CRBSI发生率增加。

To investigate the applicability of NMF criteria in determining the optimal timing for initiating RRT in patients experiencing AKI following liver transplantation.

A retrospective analysis was conducted on the clinical data of patients with AKI following liver transplantation, who were admitted to ICU at LiHuili Hospital, affiliated of Ningbo University, from January 2018 to June 2023. Based on previous research findings, criteria for NMF were established, and 173 patients were categorized into four distinct groups: (1) Group A (n=41), comprising patients who met the NMF criteria and received renal replacement therapy (RRT) within 6 hours of ICU admission; (2) Group B (n=55), consisting of patients who met the NMF criteria but either did not receive RRT or received RRT after ≥ 6 hours post-ICU admission; (3) Group C (n=18), including patients who did not meet the NMF criteria but received RRT within 6 hours of ICU admission; and (4) Group D (n=59), comprising patients who neither met the NMF criteria nor received RRT, or who received RRT after ≥ 6 hours post-ICU admission. Conduct a comprehensive analysis and comparison of patient demographic and clinical characteristics, including age, gender, BMI, etiology, SOFA score, APACHE Ⅱ score, timing of transplant surgery, surgical technique, and incidence of hepatic coma. Evaluate clinical indicators such as serum creatinine, MELD-Na score, and blood ammonia levels preoperatively, postoperatively, and on the third and seventh days following transplantation. Assess prognostic outcomes by examining cumulative durations of mechanical ventilation, ICU stay, and total hospitalization, as well as 28-day, 90-day, and 1-year mortality rates. Additionally, evaluate the occurrence of CRBSI, CKD, liver dysfunction, and the requirement for long-term RRT. For intergroup comparisons, employ the t-test for normally distributed continuous variables, the Mann-Whitney U test for non-normally distributed continuous variables, and the chi-square test or Fisher′s exact test for categorical variables. A P-value of less than 0.05 will be considered indicative of a statistically significant difference.

Statistically significant differences were observed in serum creatinine and blood ammonia levels between patients in Group A and Group B on the third and seventh days following surgery, as well as in MELD-Na scores on postoperative day 7 (U/t= 2.245.30, 7.37, 7.55, 2.73, all P<0.05). Significant differences in serum creatinine and blood ammonia levels were noted between patients in Group C and Group D on the third day post-surgery (U=2.21 and 5.20, both P<0.05). Furthermore, significant differences were identified in the total length of hospital stay and the incidence of tracheostomy, concurrent CKD and long-term RRT between Group A and Group B (t/χ²=3.23, 4.59, 3.93, all P<0.05). Additionally, a statistically significant difference was found in the incidence of CRBSI between Group C and Group D (P<0.05).

According to the NMF criteria, patients with AKI who receive RRT following liver transplantation demonstrate significant improvements in postoperative serum creatinine levels, MELD-Na scores, and blood ammonia levels. Additionally, these patients experience a reduced total hospital stay, a lower incidence of CKD complications, and a decreased necessity for long-term RRT. Conversely, patients who do not meet the NMF criteria yet undergo RRT exhibit a heightened incidence of CRBSI.