小儿肝移植术后急性肺损伤与血管内皮糖萼的关系  

Correlation between acute lung injury and vascular endothelial glycocalyx after paediatric liver transplantation

作　　者：秦鋆建 梁胜凤 朱馥如[1] 陶春辉 周斌先 蓝雨雁[1] QIN Yun-jian;LIANG Sheng-feng;ZHU Fu-ru;TAO Chun-hui;ZHOU Bin-xian;LAN Yu-yan(Department of Anesthesiology,the First Hospital of Guangxi Medical University,Nanning 530021,Guangxi,China;不详)

机构地区：[1]广西医科大学第一附属医院麻醉科,广西南宁530021 [2]广西壮族自治区人民医院麻醉科,广西南宁530021

出　　处：《广东医学》2023年第7期832-837,共6页Guangdong Medical Journal

基　　金：广西自然科学基金项目(2018GXNSFAA281101);广西医疗卫生适宜技术开发与推广应用项目(S2019109)。

摘　　要：目的探讨小儿肝移植术后急性肺损伤与血管内皮糖萼的关系。方法选择行肝移植手术的肝病患儿51例,男31例,女20例,0~14岁,ASAⅢ或Ⅳ级。检测并记录切皮前(T_(0))、门静脉阻断前10 min(T_(1))、无肝期30 min(T_(2))、新肝期30 min(T_(3))、新肝期2 h(T_(4))、手术结束(T_(5))时动脉血中内皮糖萼成分多配体蛋白聚糖1(syndecan-1,sdc-1)的浓度。根据术后是否发生急性肺损伤分为两组:术后发生急性肺损伤为肺损伤组(S组,n=15)和术后未发生急性肺损伤为对照组(D组,n=36)。记录术中无肝期时间、冷缺血时间、总输液量、输血量、出血量、尿量、术后血气分析、肝功能、ICU治疗时间、气管导管拔管时间以及肺部感染、急性肺损伤等发生情况。采用单因素及多因素logistic回归并绘制受试者工作特征(ROC)曲线评估sdc-1对术后急性肺损伤的预测效能。结果与T_(1)时比较,T_(3)、T_(4)时两组sdc-1浓度明显升高;与D组比较,T_(3)~T_(5)时S组sdc-1浓度明显升高(P<0.05)。与D组比较,S组术中冷缺血时间明显延长,红细胞输注量、出血量、尿量明显增多(P<0.05)。二元多因素logistic回归分析结果显示:sdc-1(OR=1.214,95%CI:1.033~1.396)是术后急性肺损伤的独立危险因素(P<0.05)。ROC曲线分析显示,T3时sdc-1预测术后急性肺损伤的ROC曲线下面积(AUC)为0.772。根据术中sdc-1浓度最大值与截断值比较分为两组:高sdc-1组(H组,n=32)与低sdc-1组(L组,n=19)。与L组相比,H组术后1 d氧合指数较低(P<0.05),术后气管导管拔管时间延长以及肺部感染、急性肺损伤发生率增加(P<0.05)。结论术中内皮糖萼受损可导致术后拔气管导管时间延长以及肺部感染、急性肺损伤发生率增加,sdc-1升高对术后急性肺损伤有一定的预测价值。Objective To investigate the relationship between acute lung injury(ALI)and endothelial glycocalyx in pediatric liver transplant recipients.Methods A total of 51 pediatric patients with liver disease undergoing liver transplantation were included in the study,consisting of 31 males and 20 females,aged between 0 and 14 years,with ASA gradesⅢorⅣ.The concentration of syndecan-1(sdc-1),a component of endothelial glycocalyx,was measured in arterial blood at different time points during the surgery:before skin incision(T_(0)),10 minutes before portal vein occlusion(T_(1)),30 minutes after liver removal(T_(2)),30 minutes after graft reperfusion(T_(3)),2 hours after graft reperfusion(T_(4)),and at the end of surgery(T_(5)).The patients were divided into two groups based on the occurrence of postoperative ALI:the ALI group(S group,n=15)and the control group(D group,n=36).Intraoperative variables,postoperative blood gas analysis,liver function,ICU treatment time,endotracheal extubation time,and the incidence of pulmonary infection and ALI were recorded.Single-factor and multi-factor logistic regression were used,and ROC curve analysis was performed to evaluate the predictive performance of sdc-1 for postoperative ALI.Results Compared to T_(1),sdc-1 concentration was significantly increased at T_(3) and T_(4) in both groups.Compared to the D group,sdc-1 concentration was significantly higher in the S group from T_(3) to T_(5)(P<0.05).Additionally,the S group had significantly prolonged cold ischemia time,red blood cell transfusion,blood loss,and urine output compared to the D group(P<0.05).Multi-factor logistic regression analysis showed that sdc-1(OR=1.214,95%CI:1.033-1.396)was an independent risk factor for postoperative ALI(P<0.05).ROC curve analysis revealed that the area under the curve(AUC)for sdc-1 in predicting postoperative ALI at T_(3) was 0.772.According to the comparison of sdc-1 concentration with the cutoff value,patients were divided into two groups:high sdc-1 group(H group,n=32)and low sdc-1 group(L grou

关 键 词：小儿 肝移植 血管内皮糖萼 急性肺损伤 

分 类 号：R614.2[医药卫生—麻醉学] R782.054[医药卫生—外科学]