围手术期体温变化与肝移植早期移植物功能不全的关系  

Relationship of perioperative temperature changes to early graft insufficiency in liver transplantation

作　　者：徐磊 张韬 张真真 曹林 周斌 Xu Lei;Zhang Tao;Zhang Zhenzhen;Cao Lin;Zhou Bin(Department of Anesthesiology,General Hospital of Eastern Theater Command,PLA,Jiangsu Nanjing 210002,China)

机构地区：[1]东部战区总医院麻醉科,江苏南京210002

出　　处：《实用器官移植电子杂志》2025年第1期12-16,共5页Practical Journal of Organ Transplantation(Electronic Version)

摘　　要：目的探讨围手术期不同时间的体温变化是否与早期移植物功能不全(earlyallograftdysfunction,EAD)的发生率具有相关性。方法选取在东部战区总医院2020年12月1日至2023年11月30日期间接受肝移植的272例受者,收集受者围手术期临床数据和不同时间的体温数据,通过倾向性评分匹配其他一般资料,找出有意义的体温数据,分析体温变化与EAD的相关性。结果纳入的272例受者中EAD有86例,发生率为31.2%。经过1:1倾向评分匹配后,共匹配到56对受者,分为EAD组(n=56例)和NO-EAD组(n=56例)。新肝期下腔静脉开放后1 h温度变化(△T_(4))两组之间具有明显差异(t=2.382,P=0.019),取ROC曲线的最佳截断值0.45℃,发现△T_(4)低于0.45℃的受者EAD发生率是高于0.45℃的2.901倍(95%CI=1.181~7.125,P=0.020)。结论新肝期下腔静脉开放后1h温度变化与EAD具有一定的相关性,体温升高至正常温度越快,EAD发生率越低,术中体温变化可以反映早期新肝功能的恢复情况,新肝期体温上升不良应引起临床医生的警惕。Objective To explore whether temperature changes at different times in the perioperative period correlate with the incidence of early allograft dysfunction(EAD).Methods Recipients who underwent liver transplantation in the Eastern Theater General Hospital between December 1,2020,and November 30,2023 were selected,and perioperative clinical data and temperature data at different times of the recipients were collected,and meaningful body temperature was identified by propensity score matching with other general information data to analyze the correlation of early graft insufficiency with temperature changes.Results There were 86 cases of EAD among 272 recipients,with an incidence of 31.2%.After 1:1 propensity score matching,a total of 56 pairs of recipients were matched:divided into the EAD group(n=56 cases),and the NO-EAD group(n=56 instances).The temperature change 1 h after the opening of the inferior vena cava in the neo-hepatic phase(△T_(4))was significantly different between the two groups(t=2.382,P=0.019),and with the optimal truncation value of the ROC curve 0.45℃,it was found that the incidence of EAD in recipients with△T_(4) lower than 0.45℃was 2.901 times higher than that higher than 0.45℃(95%CI=1.181~7.125,P=0.020).Conclusion Temperature change 1 h after opening of the inferior vena cava in the anhepatic phase has a certain correlation with the early graft insufficiency,and the faster the body temperature increases,the earlier the early graft function recovers.The quicker the body temperature rises to its normal temperature,the lower the incidence of early graft insufficiency.Intraoperative temperature changes can reflect the recovery of new liver function at an early stage,and the poor rise of body temperature in the new liver stage should arouse the vigilance of clinicians.

关 键 词：肝移植 早期移植物功能不全 温度变化 倾向性评分匹配 

分 类 号：R657.3[医药卫生—外科学]