加速康复外科方案改善肝移植受者结局

Enhanced recovery after surgery improves clinical outcomes of liver transplant recipients

目的探讨加速康复外科(ERAS)方案在肝移植受者中实施的合理性及有效性。方法回顾性分析465例肝移植受者的临床资料。根据有否接受ERAS方案治疗将受者分为ERAS组(163例)和对照组(302例),ERAS组病情重于对照组。观察并记录肝移植受者的手术情况,包括手术时间、无肝期、术中输血量;记录肝移植受者的术后恢复情况,包括术后重症监护室(ICU)住院时间、总住院时间、术后28 d总撤除呼吸机时间、术后再插管率;记录肝移植受者术后90、180 d及1年的生存率,分析肝移植受者生存率的影响因素。结果ERAS组受者的无肝期为45(39,53)min,明显长于对照组的40(32,48)min(P<0.05)。ERAS组红细胞输注量为10(7,13)U,明显少于对照组的18(10,28)U(P<0.05)。ERAS组受者的术后ICU住院时间、总住院时间分别为135(84,212)h、24(18,33)d,均短于对照组的154(103,253)h、34(20,50)d(均为P<0.05)。ERAS组受者的术后28 d总撤除呼吸机时间为26(25,27)d,明显长于对照组的26(23,27)d(P<0.05)。ERAS组受者的术后再插管率为11.0%,明显低于对照组的20.8%(P<0.05)。ERAS组受者术后90、180 d以及1年的生存率均为92.8%,均明显高于对照组受者的81.1%、78.1%、75.7%(均为P<0.05)。ERAS和手术时间是肝移植受者生存率的独立影响因素(P<0.05)。结论肝移植术后ERAS管理模式可提高受者生存率,同时可缩短受者的住院时间、降低再插管率,对肝移植术后康复具有积极的促进作用。

Objective To investigate the rationality and efficacy of enhanced recovery after surgery(ERAS)in liver transplant recipients.Methods Clinical data of 465 liver transplant recipients were retrospectively analyzed.All recipients were divided into the ERAS group(n=163)and control group(n=302)according to whether they received ERAS.The severity of disease in the ERAS group was worse than that in the control group.Operation situations including the operation time,anhepatic phase and intraoperative blood transfusion volume of the liver transplant recipients were observed and recorded.Postoperative recovery conditions including the length of intensive care unit(ICU)stay,total length of hospital stay,total ventilator removal time at postoperative 28 d and postoperative re-intubation rate were recorded.The survival rates at 90 d,180 d and 1 year after liver transplantation were calculated.The influencing factors of survival rate of liver transplant recipients were analyzed.Results The anhepatic phase in the ERAS group was 45(39,53)min,significantly longer than 40(32,48)min in the control group(P<0.05).The volume of erythrocyte infusion in the ERAS group was 10(7,13)U,significantly less than 18(10,28)U in the control group(P<0.05).The length of postoperative ICU stay and total length of hospital stay in the ERAS group were 135(84,212)h and 24(18,33)d,significantly shorter than 154(103,253)h and 34(20,50)d in the control group(both P<0.05).Total ventilator removal time at postoperative 28 d was 26(25,27)d,significantly longer than 26(23,27)d in the control group(P<0.05).The postoperative re-intubation rate in the ERAS group was 11.0%,significantly lower than 20.8%in the control group(P<0.05).The 90 d,180 d and 1-year survival rates in the ERAS group were 92.8%,which were significantly higher than 81.1%,78.1%and 75.7%in the control group(all P<0.05).ERAS and operation time were the independent influencing factors of survival rate of liver transplant recipients(both P<0.05).Conclusions ERAS after liver transplantation can improve the survival rate of recipient,shorten the length of hospital stay,reduce the re-intubation rate and accelerate the rehabilitation after liver transplantation.