摘要
目的探究原位肝移植术后机械通气时间延长(PMV)的发生率、危险因素以及对临床预后的影响。方法回顾性分析某器官移植研究所2015年1月1日一2017年12月31日行原位肝移植术的501例患者的临床资料,记录围手术期多种变量,进行单因素和多因素分析。机械通气延长定义为术后呼吸机应用时间大于24 h。结果机械通气延长患者45例(9.0%)o单因素分析发现PMV组与非PMV组患者在MELD评分(Model for end-stage liver disease,MELD)、术前气管插管、人工肝和持续替代治疗(continuous renal replacement therapy,CRRT)、合并肝性脑病、应用血管活性药物、白蛋白水平、丙氨酸氨基转移酶(alanine amino transferase,ALT)水平、术中输注大量红细胞悬液、晶体液以及新肝期尿量等方面差异有统计学意义(P<O.05)。多因素回归分析发现,术前肝性脑病、高ALT水平、术中大量输血、新肝期尿量较少是导致术后PMV的独立危险因素。PMV患者住重症监护室(ICU)时间、住院时间较非PMV组延长,一年死亡率增加。结论肝移植术后机械通气延长与术前肝性脑病、高丙氨酸转氨酶水平、术中大量输血、新肝期尿量较少等多因素相关,机械通气延长可导致住ICU时间、住院时间延长,死亡率增加。
Objective To analyze the incidence,clinical risk factors and prognosis of prolonged mechanical ventilation(PMV)in orthotopic liver transplantation.Methods Totally 501 patients who underwent orthotopic liver transplantation in the Department of tranaplant surgery of our hospital from 2015 to 2017 were analyzed retrospectively.Perioperative variables were analyzed as risk factors.PMV was defined as time of postoperative ventilation>24 hours.Results There were 45 patients(9.0%)who matched the diagnosis criterion of PMV.The intergroup comparisons revealed worse preoperative hepatic conditions,more supportive therapy,usage of more packed red bloodcellsand less urine output in PMV groupcompared with the non-PMV group(P<0.05).Multivariate analysis showed that preoperative presence of hepaticencephalopathy,high alanine amino transferaselevels,intraoperative usage of more packed red bloodcells,and lessurine volume during neograft of liver transplantation were the independentrisk factors for PMV after liver transplantation.The PMV group had significantly increased risks of postoperative mortalityand ICU stay time,hospital stay compared with the non-PMV group.Conclusions Preoperative presence of hepaticencephalopathy,high alanine amino transferaselevels,intraoperative usage of more packed red bloodcells,and less urine volume during neograft of liver transplantation are separately associated with PMV after liver transplantation.PMV can lead to prolonged ICU stay time,prolonged hospital stayand increased postoperative mortality.
作者
朱春红
杨洋
雷联会
ZHU chun-hong;YANY Yang;LEI Lian-hui(Beijing Railway Center Health and Epidemic Prevention Station Huicheng Gate Clinic,Beijing 100039,China)
出处
《中国急救复苏与灾害医学杂志》
2019年第11期1060-1063,共4页
China Journal of Emergency Resuscitation and Disaster Medicine
基金
北京市自然科学基金(7172242)。
关键词
肝移植
机械通气延长
危险因素
预后
Prolonged mechanical ventilation
liver transplantation
Risk factors
prognosis
