肝移植患者术后气管导管延迟拔管的危险因素  

Risk factors of delayed extubation of endotracheal catheter in patients undergoing liver transplantation

作　　者：韦玉枝 张欢[1] 王琳琳[1] 杨博[1] 齐子恒 封春雨 WEI Yuzhi;ZHANG Huan;WANG Linlin;YANG Bo;QI Ziheng;FENG Chunyu(Beijing Tsinghua Changgung Hospital,School of Clinical Medicine,Tsinghua University,Beijing 102218,China)

机构地区：[1]清华大学附属北京清华长庚医院麻醉科、清华大学临床医学院,102218

出　　处：《临床麻醉学杂志》2023年第6期571-576,共6页Journal of Clinical Anesthesiology

基　　金：清华大学精准医学科研计划项目(20229990039);清华大学精准医学科研计划战略项目(2022ZLB009)。

摘　　要：目的探讨行肝移植手术患者术后气管导管延迟拔管的危险因素。方法回顾性分析2018年1月至2021年10月于全麻下行肝移植手术患者339例,男264例,女75例,年龄18~80岁,BMI 14~35 kg/m^(2),ASAⅡ—Ⅴ级。根据术后24 h内是否拔除气管导管分为两组:正常拔管组和延迟拔管组。采用单因素分析延迟拔管相关的影响因素,多因素Logistic回归分析筛选肝移植术后延迟拔管的独立危险因素。结果有60例(17.7%)患者术后延迟拔管。与正常拔管组比较,延迟拔管组终末期肝病模型(MELD)评分明显升高(P<0.05),手术时间、冷缺血时间明显延长(P<0.05),术中严重低血压发生率明显升高(P<0.05),术中6%羟乙基淀粉输入量、浓缩红细胞输入量、血浆输入量明显增多,(P<0.05)。多因素Logistic回归分析显示,MELD评分≥17分(OR=1.829,95%CI 1.004~3.333,P=0.049)、浓缩红细胞输入量>4 U(OR=3.264,95%CI 1.650~7.271,P=0.001)和冷缺血时间≥480 min(OR=2.314,95%CI 1.069~5.008,P=0.033)是成人肝移植术延迟拔管的独立危险因素。结论术前MELD评分≥17分、术中浓缩红细胞输入量>4 U、冷缺血时间≥480 min是肝移植患者术后延迟拔管的独立危险因素。Objective To investigate the risk factors of delayed extubation of endotracheal catheter in patients undergoing liver transplantation.Methods A total of 339 patients undergoing liver transplantation under general anesthesia were included,including 264 males and 75 females,aged 18-80 years,BMI 14-35 kg/m^(2),ASA physical statusⅡ-Ⅴ.According to whether the extubation time of endotracheal catheter was within 24 hours after surgery,the patients were divided into two groups:normal extubation group and delayed extubation group.Risk factors associated with delayed extubation were analyzed using univariate analysis and independent risk factors for delayed extubation after liver transplantation were analyzed by multivariate logistic regression.Results There were 60 patients(17.7%)with delayed extubation.Compared with the normal extubation group,the model score of end-stage liver disease(MELD)in the delayed extubation group was significantly greater(P<0.05),the operation time and cold ischemia time were significantly prolonged(P<0.05),the intraoperative severe hypotension events were significantly increased(P<0.05),and the intraoperative input of 6%hydroxyethyl starch(P<0.05),the packed red blood cell input and plasma input were significantly increased(P<0.05).Multivariate Logistic analysis revealed that MELD score≥17(OR=1.829,95%CI 1.004-3.333,P=0.049),intraoperative transfusion of packed red blood cells>4 U(OR=3.264,95%CI 1.650-7.271,P=0.001),and the cold ischemia time≥480 minutes(OR=2.314,95%CI 1.069-5.008,P=0.033)were independent risk factors for delayed extubation after liver transplantation in adults.Conclusion Preoperative MELD score≥17,intraoperative transfusion of packed red blood cells>4 U,the cold ischemia time≥480 minutes are independent risk factors for delayed extubation in patients undergoing liver transplantation.

关 键 词：肝移植 延迟拔管 危险因素 

分 类 号：R614[医药卫生—麻醉学]