肝移植术门静脉开放10 min内血钾变化及危险因素  

CHANGE IN SERUM POTASSIUM WITHIN TEN MINUTES AFTER PORTAL VEIN OPENING IN LIVER TRANSPLANTATION AND RELATED RISK FACTORS

作　　者：栾佳萍 董河[1] 刘爱杰[1] 祝琳[1] 徐庆国 LUAN Jiaping;DONG He;LIU Aijie;ZHU Lin;XU Qingguo(Department of Anesthesiology,The Affiliated Hospital of Qingdao University,Qingdao 266003,China)

机构地区：[1]青岛大学附属医院麻醉科,山东青岛266003 [2]青岛大学附属医院器官移植中心,山东青岛266003

出　　处：《青岛大学学报（医学版）》2022年第1期105-109,共5页Journal of Qingdao University(Medical Sciences)

基　　金：国家自然科学基金青年科学基金项目(81900575)。

摘　　要：目的观察肝移植术门静脉开放后10 min内血钾变化趋势,并探讨门静脉开放后发生高钾血症的相关危险因素。方法收集2019年5—12月于我院行肝移植术100例病人的临床资料,分别于麻醉诱导后(T0)、无肝期末(T1)、门静脉开放即刻(T2)、门静脉开放后20 s(T3)、门静脉开放后40 s(T4)、门静脉开放后1 min(T5)、门静脉开放后2 min(T6)、门静脉开放后5 min(T7)、门静脉开放后10 min(T8)采集动脉血测定血钾浓度,比较门静脉开放前后血钾变化。以门静脉开放后血钾浓度≥5.5 mmol/L病人为高钾组,门静脉开放后血钾浓度<5.5 mmol/L病人为非高钾组。单因素分析高钾组和非高钾组间血钾的差异,Logistic回归模型分析发生高钾血症的相关危险因素。结果门静脉开放后10 min内血钾浓度呈先升高后降低的趋势。Logistic回归分析显示,冷缺血时间(OR=1.148,P<0.05)、无肝期末血钾(OR=9.759,P<0.05)、供体脂肪肝(OR=1.253,P<0.05)为门静脉开放后10 min内发生高钾血症的独立危险因素。结论肝移植术新肝期门静脉开放后10 min内血钾浓度起伏大,易导致剧烈血流动力学参数波动,应早期有效预防,减少高钾血症的发生。Objective To investigate the change in serum potassium within 10 minutes after portal vein opening in liver transplantation and the risk factors for hyperkalemia after portal vein opening.Methods Clinical data were collected from 100 patients who underwent liver transplantation in our hospital from May to December,2019.Arterial blood samples were collected after anesthesia induction(T0),at the end of anhepatic phase(T1),immediately after portal vein opening(T2),at 20 s after portal vein opening(T3),at 40 seconds after portal vein opening(T4),at 1 min after portal vein opening(T5),at 2 min after portal vein opening(T6),at 5 min after portal vein opening(T7),and at 10 min after portal vein opening(T8)to measure the serum level of potassium and observe the change in serum potassium before and after portal vein opening.The patients with serum potassium≥5.5 mmol/L after portal vein opening were enrolled as hyperkalemia group,and those with serum potassium<5.5 mmol/L were enrolled as non-hyperkalemia group.A univariate analysis was used to investigate the difference in serum potassium between the hyperkalemia group and the non-hyperkalemia group,and a Logistic regression model analysis was used to investigate the risk factors for hyperkalemia.Results Serum potassium first increased and then decreased within 10 min after portal vein opening.The logistic regression analysis showed that cold ischemia time(OR=1.148,P<0.05),serum potassium at the end of anhepatic phase(OR=9.759,P<0.05),and donor fatty liver(OR=1.253,P<0.05)were independent risk factors for hyperkalemia within 10 min after portal vein opening.Conclusion There is a great fluctuation in serum potassium within 10 min after portal vein opening during liver transplantation,which can easily lead to drastic hemodynamic fluctuation.Early effective prevention should be performed to reduce hyperkalemia.

关 键 词：肝移植 高钾血症 危险因素 冷缺血 组织供者 

分 类 号：R614.2[医药卫生—麻醉学]