摘要
目的探讨儿童肝移植受者重返重症监护室(ICU)的危险因素,为儿童肝移植术后临床决策提供参考。方法回顾性分析2019至2021年上海交通大学医学院附属仁济医院接受肝移植手术后所有转入ICU患儿的临床资料,统计住院期间重返ICU的情况,以及重返的原因。以1∶3比例匹配未发生重返ICU的患儿作为对照组,比较两组患儿基本信息、移植后转出ICU当天的生命体征及各项实验室指标、免疫抑制剂种类及药物浓度等。采用多因素Logistic回归分析探讨儿童肝移植受者重返ICU的危险因素。结果儿童肝移植术后ICU重返率为4.36%,其中48 h内重返率为16.00%,主要原因包括呼吸系统并发症、腹腔感染和肝血管栓塞。多因素Logistic回归分析显示,术后输注红细胞(OR=4.554,95%CI=1.743~11.901,P=0.002)、高血尿酸(OR=1.005,95%CI=1.001~1.009,P=0.014)是重返ICU的危险因素;高舒张压(OR=0.922,95%CI=0.885~0.960,P<0.001)和高总蛋白水平(OR=0.937,95%CI=0.891~0.986,P=0.012)是重返ICU的保护因素。结论术后输注红细胞、高血尿酸水平是儿童肝移植受者重返ICU的独立危险因素。
Objective To explore the risk factors for the returning of pediatric liver transplant recipients to the intensive care unit(ICU)and provide reference for the clinical decision-making after surgery.Methods A retrospective analysis was conducted with the information of all the pediatric patients who underwent liver transplantation in Ren Ji Hospital,Shanghai Jiao Tong University School of Medicine and were returned to the ICU from 2019 to 2021.The patients returned to the ICU during hospitalization and the reasons for the return were recorded.Each patient of ICU return was matched with three pediatric patients who did not return to the ICU during hospitalization.The basic information,the vital signs and laboratory indicators on the day of transfer from ICU,immunosuppressants and drug concentrations were compared between the two groups.Multivariate Logistic regression analysis was performed to explore the risk factors for the returning of pediatric liver transplant recipients to the ICU.Results The returning rate of pediatric liver transplant recipients to the ICU was 4.36%,and it was 16.00% within 48 h.The main reasons for the return included respiratory complications,abdominal infections,and hepatic vascular occlusion.Multivariate Logistic regression analysis showed that post-operative red blood cell transfusion(OR=4.554,95%CI=1.743-11.901,P=0.002)and high serum level of uric acid(OR=1.005,95%CI=1.001-1.009,P=0.014)were the risk factors for returning to the ICU.High diastolic blood pressure(OR=0.922,95%CI=0.885-0.960,P<0.001)and high total protein level(OR=0.937,95%CI=0.891-0.986,P=0.012)were the protective factors for returning to the ICU.Conclusion Post-operative red blood cell transfusion and high serum level of uric acid are independent risk factors for the returning of pediatric liver transplant recipients to the ICU.
作者
高磊青
戚丽婷
金晶
顾燕芬
陆晔峰
GAO Leiqing;QI Liting;JIN Jing;GU Yanfen;LU Yefeng(Department of Nursing,Ren Ji Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200127,China;Department of Liver Surgery,Ren Ji Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200127,China)
出处
《中国医学科学院学报》
CAS
CSCD
北大核心
2024年第5期678-684,共7页
Acta Academiae Medicinae Sinicae
基金
上海市科技创新行动计划软科学研究(23692108400)
上海交通大学医学院附属仁济医院临床研究项目(IIT-2022-0172)
上海交通大学医学院附属仁济医院护理临床课题(hlbynkt2023-004)
上海交通大学医学院护理学科建设项目(〔2022〕1号)。
关键词
肝移植
儿童受者
重返重症监护室
危险因素
liver transplantation
pediatric recipient
returning to the intensive care unit
risk factor
