313例原位肝移植受者术后早期肺部并发症危险因素分析  

Analysis of risk factors of early pulmonary complications after orthotopic liver transplantation:a report of 313 cases

作　　者：刘新阳 张慧 郑智滢 潘熊熊 Liu Xinyang;Zhang Hui;Zheng Zhiying;Pan Xiongxiong(Department of Anesthesiology and Perioperative medicine,the First Affiliated Hospital of Nanjing Medical University,Nanjing 210029,China;Hepatobiliary Center,The First Affiliated Hospital of Nanjing Medical University,Nanjing 210029,China)

机构地区：[1]南京医科大学第一附属医院麻醉与围手术期医学科,南京210029 [2]南京医科大学第一附属医院肝胆中心,南京210029

出　　处：《中华器官移植杂志》2022年第3期141-145,共5页Chinese Journal of Organ Transplantation

基　　金：江苏省卫计委青年医学重点人才资助项目(QNRC2016586)。

摘　　要：目的探讨原位肝移植术前供、受者基本特征及术中情况对于术后肺部并发症、围手术期存活率等方面的影响。方法回顾性分析2016年1月至2019年12月在南京医科大学第一附属医院接受原位肝移植手术的313例受者的临床资料。根据术后7 d内受者的临床表现、实验室指标和影像学检查结果确定是否患有术后肺部并发症,并将受者分为术后肺部并发症组(189例)和无术后肺部并发症组(124例)两组。将两组受者术前及术中资料单因素分析中有统计学意义的变量纳入多因素Logistic回归模型,分析早期术后肺部并发症发生的危险因素,并对受者术后生存情况进行Kaplan-Meier生存分析。结果多因素Logistics回归分析显示,受者年龄、合并慢性病、术前血小板计数低、术中大量出血(>1500 ml)、灌注后严重低血压都是术后肺部并发症发生的独立危险因素。与无术后肺部并发症组比较,术后肺部并发症组受者ICU停留时间、术后机械通气时间以及住院时间延长,再次气管插管率、急性肾损伤(AKI)发生率和院内死亡率增加(P<0.05)。良性肝病肝移植受者中,无术后肺部并发症组受者的围手术期总存活率优于术后肺部并发症组的受者(P<0.05)。结论年龄、合并慢性病、术前血小板计数低、术中大量出血(>1500 ml)、灌注后严重低血压会增加原位肝移植受者术后早期术后肺部并发症发生风险,对受者产生不利影响。Objective To explore the effects of donor,basic recipient characteristics and intraoperative findings before orthotopic liver transplantation(OLT)on postoperative pulmonary complications and the influence of postoperative pulmonary complications on postoperative outcomes and long-term survival of patients.Methods From January 2016 to December 2019,clinical data were retrospectively reviewed for 313 OLT recipients at First Affiliated Hospital,Nanjing Medical University.According to clinical manifestations,laboratory parameters and imaging findings within 7 days post-operation,they were divided into two groups of with and without postoperative pulmonary complications.Univariate and multivariate Logistic regression analyses were performed for general parameters of donors/recipients and perioperative variables of recipients in two groups.And Kaplan-Meier survival analysis was conducted for postoperative survival of two groups.Results Multiariate Logistic regression analysis indicated that age,concurrent chronic diseases,low preoperative platelet count,intraoperative massive bleeding(>1500 ml)and severe hypotension after perfusion were all independent risk factors for postoperative pulmonary complications.Compared with those without postoperative pulmonary complications,intensive care unit(ICU)stay,postoperative mechanical ventilation duration and hospital stay were significantly prolonged in patients with postoperative pulmonary complications.And rate of re-intubation,incidence of acute kidney injury and hospital mortality spiked markedly(P<0.05).Among OLT patients with benign liver diseases,overall survival rate of patients without postoperative pulmonary complications was significantly better than that of those with postoperative pulmonary complications(P<0.05).Conclusions Age,concurrent chronic diseases,low preoperative platelet count,massive intraoperative bleeding(>1500 ml)and severe hypotension after perfusion boost the risks of early postoperative pulmonary complications and adversely affect the outcomes of OL

关 键 词：肝移植 肝移植术后并发症 危险因素 

分 类 号：R657.3[医药卫生—外科学]