肝移植术后患者早期呼吸机脱机延迟的术前及术中危险因素

目的 分析肝移植术后患者早期呼吸机脱机延迟的术前及术中危险因素.方法 2004年9月至2006年8月212例肝移植术患者,其中男性152例,女性60例,年龄22～69岁.术中常规麻醉管理,按输血原则输入血制品,并维持平均动脉压不低于60 mm Hg.记录16个术前变量和7个术中变量.术后24 h按第1次拔除气管导管时间分为正常脱机组和脱机延迟组.结果 两组间9个术前变量分别为年龄＞64岁、PaO2＜75 mm Hg、胸膜渗出、Ⅲ级以上肝性脑病、合并自发性细菌性腹膜炎、晚期肝病模型(MELD)评分、血清白蛋白、腹水≥20 ml/kg和中度门肺高压]及5个术中变量RBC输入量、新鲜冰冻血浆输入量、晶体液输入量、胶体液输入量和尿量＜1 ml·kg-1·h-1]差异有统计学意义(P＜0.05或0.01).logistic回归分析显示,5个术前变量(年龄＞64岁、PaO2＜75 mm Hg、Ⅲ级以上肝性脑病、MELD评分和中度门肺高压)及2个术中变量(RBC输入量和尿量＜1 ml·kg-1·h-1)与术后脱机延迟存在相关性(P＜0.05或0.01).结论 5个术前变量(年龄＞64岁、术前PaO2＜75 mm Hg、Ⅲ级以上肝性脑病、MELD评分和中度门肺高压)及2个术中变量(RBC输入量和尿量＜1 ml·kg-1·h-1)是肝移植术后患者早期脱机延迟的危险因素.

Pre-and intraoperative risk factors associated with delayed weaning from ventilator during the early postoperative period in patients undergoing liver transplantation

Objective To evaluate the pre-and intraoperative risk factors associated with delayed weaning from ventilator during the early postoperative period in patients undergoing liver transplantation.Methods Two hundred and twelve patients(152 male,60 female)aged 22-69 yr undergoing liver transplantation from Sept.2004 to Aug.2006 were enrolled in this study and were divided into 2 groups according to the time when the patients were weaned from ventilator:A normal weaning group(the patients were weaned from ventilator ≤24 h after operation)and B delayed weaning group(＞24 h after operation).Routine anesthesia performed.Blood and blood products were transfused according to the guidelines for blood transfusion to maintain MAP≥60 mm Hg during operation.Sixteen preoperative variables(age＞64 yr,gender,BMI≥30 kg/m2,PaO2＜75 mm Hg,pleural effusion,a history of asthma,smoking,drinking alcohol,coronary artery disease,diabetes mellitus,encephalopathy＞grade 3,spontaneous bacterial peritonitis,preoperative MELD score,serum albumin,ascites≥20 ml/kg and moderate hepato-pulmonary hypertension)and 7 intraoperative variables(duration of operation,variables between the 2 groups:age＞64 yr,PaO2＜75 mm Hg,encephalopathy ＞grade 3,preoperative MELD confirmed to be associated with delayed weaning from ventilator by using logistic regression analysis(P＜0.05 or 0.01).Conclusion Age＞64 yr,preoperative PaO2＜75 mm Hg,encephalopathy＞grade 3,preoperative MELD h-1 are confirmed to be associated with delayed weaning from ventilator during early postoperative period after liver transplantation.