术前β受体阻滞剂对肝移植术中循环管理及术后短期心肌损伤和脑卒中的影响:一项倾向评分匹配研究

Effects of preoperative beta blockers on intraoperative circulation management and short-term myocardial injury and stroke after liver transplantation: a propensity-matched study

目的采用倾向评分匹配研究方法,回顾性分析术前使用β受体阻滞剂对肝移植患者术中输血量、升压药使用、再灌注后综合征以及术后30 d内心肌损伤、脑卒中发生率的影响。方法选取加州大学洛杉矶分校罗纳德里根医学中心2005年10月至2014年9月期间接受肝移植手术的患者,按照术前是否使用β受体阻滞剂分为:β受体阻滞剂组(术前持续使用β受体阻滞剂≥7 d)643例和非β受体阻滞剂组809例。两组术前变量的差异采用单因素分析,选取P<0.05的变量和与重要临床状态密切相关的变量进入Logistic回归方程模型,之后对两组间按照1∶1进行倾向评分匹配,比较匹配后组间在肝移植术中输血量、升压药使用情况、再灌注后综合征发生率及术后30 d内心肌损伤、脑卒中的发生率。结果2102例患者入选本研究,单因素分析显示,使用β受体阻滞剂组患者年龄较大、男性较多,高血压、冠心病、糖尿病、胃肠道出血的发病率更高。经Logistic回归、倾向评分匹配后每组各442例患者(共884例),组间在术中输血量[(18.8±16.2)vs(20.5±18.3)U,P=0.155]、升压药使用情况(77.4%vs 79.0%,P=0.569)、再灌注后综合征发生率(14.7%vs 14.9%,P=0.901)以及术后第30天心肌损伤(3.8%vs 4.3%,P=0.761)和脑卒中(0.7%vs 2.0%,P=0.143)的发生率方面,差异均无统计学意义。结论肝移植术前使用β受体阻滞剂≥7 d不会增加术中输血量、升压药的使用以及再灌注后综合征的发生率,对术后第30天心肌损伤或缺血性脑卒中的发生率没有影响。终末期肝病患者在接受肝移植前可以继续使用β受体阻滞剂。

ObjectiveTo retrospectively analyze the effect of preoperative use ofβ-blockers on blood transfusion volume,use of pressor drugs,post-reperfusion syndrome,and incidence of heart muscle injury and stroke within 30 d after operation during liver transplantation(LT)by a propensity-matched study.MethodsA retrospective study was performed on the patients who underwent LT at UCLA Ronald Reagan medical center between October 2005 and September 2014 after the approval of the Institutional Review Board of the university(IRB#11-003058).According to the preoperative use ofβ-blockers or not,these patients were divided intoβ-blockers group(n=643)and nonβ-blockers group(n=809).The difference of preoperative variables between the 2 groups was analyzed by single factor analysis.The variables with a value of P<0.05 and those of important relevant clinical status were selected in a logistic regression model to generate a propensity score for each patient.The patients in 2 groups were matched in 1∶1 with the nearest propensity scores.The amount of blood transfusion,use of vasopressors,incidence of post-reperfusion syndrome,and occurrence of myocardial injury and stroke within 30 d after LT were compared between the 2 groups.ResultsBased on the clinical data of 2102 patients recruited in this study,single factor analysis showed that the patients of theβ-blocker group were significantly older,larger proportion of males,and higher incidences of hypertension,coronary artery disease,diabetes,and gastrointestinal bleeding.The results of logistic regression analysis eliminated after propensity match(442 patients in each group,totally 884 patients)indicated that there were no significant differences in the amount of intraoperative blood transfusion(18.8±16.1 vs 20.3±18.0 U,P=0.155),administration of vasopressors(77.4%vs 79.0%,P=0.556),incidence of post-reperfusion syndrome(14.7%vs 14.9%,P=0.901),and occurrence of myocardial injury(3.8%vs 4.3%,P=0.761)and stroke(0.7%vs 2.0%,P=0.143)within 30 d after LT between the 2 matched groups.ConclusionPreoperative use ofβ-blockers for over 7 d has no effect on amount of blood transfusion,use of vasopressors,incidence of post-reperfusion syndrome,and occurrence of myocardial injury and stroke within 30 d after LT.The drug can be continuously administered for the patients with end-stage liver disease before undergoing LT.