术中严格血糖控制对肝移植术患者术后肝功能障碍的影响  

Effect of strict intraoperative blood glucose control on postoperative hepatic allograft dysfunction in patients undergoing liver transplantation

作　　者：崔蕾[1] 段怡 高志峰 郭娇娇 张政[1] 张欢[1] Cui Lei;Duan Yi;Gao Zhifeng;Guo Jiaojiao;Zhang Zheng;Zhang Huan(Department of Anesthesiology,Beijing Tsinghua Changgung Hospital Affiliated to Tsinghua University,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,北京102218

出　　处：《中华麻醉学杂志》2024年第5期548-552,共5页Chinese Journal of Anesthesiology

基　　金：北京市属医院科研培育计划项目(PX2021040);北京清华长庚医院青年启动基金。

摘　　要：目的评价术中严格血糖控制对肝移植术后肝功能障碍的影响。方法择期原位异体肝移植术患者164例,性别不限,年龄18~64岁,BMI 18~30 kg/m^(2),ASA分级Ⅲ或Ⅳ级,采用随机数字表法分为术中严格血糖控制组(S组,术中控制血糖6.0~7.8 mmol/L)和常规血糖控制组(C组,术中控制血糖4.1~10.0 mmol/L)。自麻醉诱导完成至术毕,每1 h测定动脉血糖,结合目标导向型血糖调控流程进行血糖管理,记录术后肝功能障碍、术后30 d内感染发生情况、脱机拔管时间、ICU停留时间和住院总时间。结果与C组比较,S组术后肝功能障碍和术后30 d内感染发生率降低(P<0.05),脱机拔管时间、ICU停留时间和住院总时间差异无统计学意义(P>0.05)。结论肝移植术中严格血糖控制可降低术后肝功能障碍的发生。Objective To evaluate the effect of strict intraoperative blood glucose control on postoperative hepatic allograft dysfunction in patients undergoing liver transplantation.Methods A total of 164 patients of both sexes,aged 18-64 yr,with body mass index of 18-30 kg/m^(2),of American Society of Anesthesiologists Physical Status classification Ⅲ or Ⅳ,undergoing orthotopic liver transplantation,were divided into strict intraoperative blood glucose control group(group S,6.0-7.8 mmol/L)and routine blood glucose control group(group C,4.1-10.0 mmol/L)using a random number table method.From the completion of anesthesia induction to the end of operation,arterial blood glucose was measured every 1 h,and blood glucose management was carried out in combination with the goal-oriented blood glucose control process.The occurrence of postoperative hepatic allograft dysfunction,infection within 30 days after surgery,offline extubation time,duration of intensive care unit stay and total length of hospital stay were recorded.Results Compared with group C,the incidence of postoperative liver dysfunction and infection within 30 days after operation were significantly decreased(P<0.05),and no significant change was found in the offline extubation time,duration of intensive care unit stay and total length of hospital stay in group S(P>0.05).Conclusions Strict blood glucose control during liver transplantation can decrease the development of postoperative liver dysfunction in patients.

关 键 词：肝移植 血糖控制 原发性移植物功能障碍 

分 类 号：R657.3[医药卫生—外科学]