摘要
目的探讨围手术期液体治疗对肝移植术后早期肺部并发症的影响。方法回顾性分析2016年4月至2017年12月在西安交通大学第一附属医院接受经典原位肝移植术的132例患者的临床资料,男性96例,女性36例,年龄(47.3±9.6)岁(范围:24~69岁)。根据术后7d内患者在ICU的临床表现、实验室及影像学检查结果确定是否发生肺部并发症,并将患者分为有肺部并发症组和无肺部并发症组。对两组围手术期指标进行单因素及多因素Logistic回归分析,并对受者2年内生存情况进行Kaplan-Meier生存分析。结果随访期间11例患者死亡,术后7d内肺部并发症发生率为54.5%(72/132),其中仅有胸腔积液34例,仅有肺水肿6例,仅有肺炎3例,胸腔积液+肺炎4例,胸腔积液+肺水肿15例,胸腔积液+肺不张6例,胸腔积液+肺水肿+肺炎4例。单因素分析结果显示,终末期肝病模型评分,手术时间,输注液体总量,血制品输入量,红细胞输注量,出血量,血浆输注量,术后24、48、72h内累积液体输注量均为肝移植术后肺部并发症的预后因素(P值均<0.05),3d中至少2d以上液体平衡≤-500ml为保护性因素。多因素分析结果显示,术中红细胞输注量>10U(OR=3.55,95%CI:1.35~9.26,P=0.01),术后72h内累积液体输注量>12L(OR=2.98,95%CI:1.14~7.80,P=0.026)是肝移植术后肺部并发症的独立预后因素。Kaplan-Meier生存分析结果显示,肺部并发症组累积生存率低于无肺部并发症组(χ^2=6.590,P=0.010)。结论术中输注红细胞过多和术后72h内累积液体输注量>12L是肝移植术后肺部并发症的独立预后因素。
Objective To investigate the effect of perioperative fluid therapy on early postoperative pulmonary complication (PPC) after orthotopic liver transplantation (OLT). Methods The clinical data of 132 patients who underwent OLT in the First Affiliated Hospital of Xi′an Jiaotong University from April 2016 to December 2017 were analyzed retrospectively. These patients included 96 males and 36 females, aged (47.3±9.6) years (range: 24-69 years). Based on the clinical manifestations, laboratory and imaging findings of patients in ICU and PPC occurrence within 7 days after OLT surgery, the patients were divided into 2 groups: non-PPC group and PPC group. Univariate and multivariate logistic regression analyses were used to evaluate the association between perioperative variables and PPC. The Kaplan-Meier method was used to estimate cumulative survival of recipients with or without PPC within 2-years. Results During the follow-up, 11 patients (8.3%) died and 72 patients (54.5%) developed PPC after operation. There were 34 cases, 6 cases, 3 cases, 4 cases, 15 cases, 6 cases and 4 cases of only pleural effusion, only pulmonary edema, only pneumonia, pleural effusion with pneumonia, pleural effusion with pulmonary edema, pleural effusion with atelectasis, and pleural effusion with pneumonia and pneumonia in PPC, respectively. Univariate analysis showed that the preoperative factors (model for end-stage liver disease score), the intra-operative factors (duration of surgery, total infusion volume, total blood products) and the postoperative cumulative fluid balance within the first 24 h, 48 h, and 72 h were the prognosis factors of PPC (P<0.05). At least two out of the first three postoperative days with a fluid balance of ≤-500 ml was a protective factor. Using multivariate analysis by Logistic regression, only the red blood units >10 U (OR=3.55, 95% CI: 1.35-9.26, P=0.010) and the cumulative fluid intake >12 L (OR=2.98, 95% CI: 1.14-7.80, P=0.026) within the first 72 h after operation were independent prognosis factors
作者
张四梅
安睿
刘琳
薛梦雯
李建鹏
王强
申新
马吉光
Zhang Simei;An Rui;Liu Lin;Xue Mengwen;Li Jianpeng;Wang Qiang;Shen Xin;Ma Jiguang(Department of Anesthesiology,the First Affiliated Hospital of Xi'an Jiaotong University,Xi'an 710061,China;Department of Hepatological Surgery,the First Affiliated Hospital of Xi'an Jiaotong University,Xi'an 710061,China)
出处
《中华外科杂志》
CAS
CSCD
北大核心
2019年第6期440-446,共7页
Chinese Journal of Surgery
基金
西安交通大学第一附属医院临床研究院基金(XJTU1AF-CRF-2016-012).
关键词
肝移植
液体治疗
肺部并发症
预后因素
Liver transplantation
Fluid therapy
Pulmonary complications
Prognosis factors
