成人肝移植术后非手术室拔管的危险因素

Risk factors of extubation in non-operating room after adult liver transplantation

目的探讨成人肝移植术后非手术室拔管的危险因素。方法选择2016—2019年全麻下行肝移植术的成年患者438例,男339例,女99例,年龄18~78岁,BMI 13~37 kg/m^(2),ASAⅡ—Ⅴ级。根据术后拔管地点分为两组:手术室拔管组和非手术室拔管组。收集患者一般资料、术前疾病信息、术前实验室指标和术中资料等。采用多因素Logistic回归分析成人肝移植术后非手术室拔管的危险因素。结果非手术室拔管患者有326例(74.4%)。与手术室拔管组比较,非手术室拔管组男性比例、ASAⅡ级比例、术前血红蛋白值与白蛋白值明显降低(P<0.05),术前终末期肝病模型(MELD)评分、国际标准化比值、总胆红素明显升高(P<0.05),凝血酶原时间、活化部分凝血活酶时间、手术时间明显延长(P<0.05),术中舒芬太尼用量、液体输入量、红细胞输注量、肾上腺素或去甲肾上腺素最大使用剂量明显增多(P<0.05)。多因素Logistic回归分析显示,吸烟史(OR=1.67,95%CI 1.01~2.78,P<0.05)、手术时间延长(OR=1.30,95%CI 1.10~1.52,P<0.05)、术中红细胞输注量增加(OR=1.12,95%CI 1.08~1.19,P<0.05)、肾上腺素或去甲肾上腺素最大剂量增加(OR=1.32,95%CI 1.00~1.61,P<0.05)是术后非手术室拔管的独立危险因素。结论吸烟史、手术时间延长、术中红细胞输注量增加以及肾上腺素或去甲肾上腺素最大剂量增加是成人肝移植术后非手术室拔管的危险因素。

Objective To investigate the risk factors of extubation in non-operating room after adult liver transplantation.Methods A total of 438 adult patients underwent liver transplantation with general anesthesia from 2016 to 2019 were included,involving 339 males and 99 females,aged 18-78 years,BMI 13-37 kg/m^(2),and ASA physical statusⅡ-Ⅴ.According to the site where tracheal extubation occurred after surgery,patients were divided into two groups:operating room extubation group and non-operating room extubation group.Datas including characteristics,information of preoperative disease,preoperative labor atory variables,and intraoperative variables were collected.Multivariate Logistic regression model was used to analyze the risk factors of extubation in non-operating room.Results There were 326(74.4%)patients in the non-operating room extubation group.Compared to the operating room extubation group,the percentage of male,the proportion of ASA physical statusⅡ,preoperative hemoglobin level,and albumin level were significantly decreased,the model for end-stage liver disease(MELD)score,international normalized ratio,and total bilirubin value were significanthy increased,prothrombin time,activated partial thromboplastin time,and the duration time of surgery were significantly prolonged,the dose of sufentanil,fluid infusion,the dose of red blood cells transfusion and the maximum dose of epinephrine or norepinephrine were significantly increased in the non-operating room extubation group(P<0.05).Multivariate Logistic analysis showed that preoperative smoking(OR=1.67,95%CI 1.01-2.78,P<0.05),increased surgery time(OR=1.30,95%CI 1.10-1.52,P<0.05),increased red blood cell transfusion(OR=1.12,95%CI 1.08-1.19,P<0.05),and increased maximum doses of epinephrine or norepinephrine(OR=1.32,95%CI 1.00-1.61,P<0.05)were independent risk factors of extubation in the non-operating room.Conclusion Preoperative smoking,increased surgery time,increased red blood cell transfusion and increased maximum dose of epinephrine or norepinephrine are independent risk factors of extubation in non-operating room after adult live transplantation.