原位肝移植术后影响机械通气时间的多因素分析

Multifactor analysis of postoperative mechanical ventilation supporting time in patients with orthotopic liver transplantation

目的研究原位肝移植术后影响患者机械通气时间的相关因素,寻找最佳术后恢复方式。方法选取肝移植术后患者100例,依据机械通气时间是否大于24小时分为A组(机械通气时间<24小时)、B组(机械通气时间>24小时)。比较两组患者术前、术中、术后临床及实验室指标,对影响机械通气时间相关危险因素进行逐步Logistic回归分析。结果与B组比较,A组术中液体入量、术中悬浮红细胞输入量、术中血浆输入量、术中出血量、术后总胆红素指标、ICU住院时间、肺水肿发生率显著减少,术中平均每小时尿量明显增加(均P<0.05)。悬浮红细胞输入量、术中平均每小时尿量以及术前胆红素水平是影响机械通气时间的独立危险因素。结论对原位肝移植危险因素进行控制可减少机械通气时间,降低围手术期相关并发症的发生。

Objective To analyze the multiple factors affecting the postoperative mechanical ventilation supporting time in patients with orthotopic liver transplantation. Methods A total of 100 patients with liver transplantation were divided into two groups,A group （postoperative mechanical ventilation supporting time〈 24 h） and B group （postoperative mechanical ventilation supporting time ＆ 24 h）.Clinical and experimental variables were analyzed between the two groups,including volume of intraoperative blood loss,volume of intraoperative liquid transfusion,hemoglobin and so on.Multiple factors affecting the postoperative mechanical ventilation supporting time were analyzed with stepwise logistic regression.Results Compared with B group,volume of intraoperative liquid transfusion,volume of intraoperative red blood cell,volume of intraoperative plasma,volume of intraoperative blood loss,postoperative bilirubin,ICU time,and postoperative pulmonary edema were significantly lower in A group （P 〈0.05）,whereas the volume of intraoperative urine per hour of A group was significantly higher.The volume of intraoperative red blood cell,volume of intraoperative urine per hour,and preoperative bilirubin were considered as the relevant independent risk factors affecting the postoperative mechanical ventilation supporting time.Conclusion Controlling risk factors in patients with orthotopic liver transplantation was beneficial in reducing the postoperative mechanical ventilation supporting time and perioperative complications.