肝移植患者术中血糖变异系数对术后早期移植物功能障碍的影响

Effect of intraoperative glycemic coefficient of variation on early allograft dysfunction in patients undergoing liver transplantation

目的探讨肝移植患者术中血糖变异系数(Glu_(cv))对术后早期移植物功能障碍(EAD)的影响。方法选择2018年2月至2020年1月接受原位异体肝移植术的患者126例,男99例,女27例,年龄28~73岁,BMI 15.2~38.2 kg/m^(2),ASAⅡ—Ⅴ级。通过医院信息系统及电话随访收集患者数据,根据术中Glu_(cv)将患者分为两组:L组(Glu_(cv)<29.8%,n=52)和H组(Glu_(cv)≥29.8%,n=74)。记录两组患者术后EAD的发生情况、术后7 d内C反应蛋白(CRP)最高值、ICU停留时间、术后30 d生存情况。结果与H组比较,L组EAD发生率明显降低(P<0.05),ICU停留时间明显缩短(P<0.05)。两组患者术后7 d内CRP最高值、术后30 d生存率差异无统计学意义。结论肝移植术中低血糖变异系数的患者术后早期移植物功能障碍发生率更低,ICU停留时间更短,肝移植术中应减少血糖波动以改善预后。

Objective To investigate the effect of glycemic coefficient of variation(Glu_(cv))on early allograft dysfunction(EAD)during liver transplantation.Methods A total of 126 patients who underwent orthotopic liver transplantation from February 2018 to January 2020 were selected,99 males and 27 females,aged 28-73 years,BMI 15.2-38.2 kg/m^(2),ASA physical statusⅡ-Ⅴ.The perioperative data were collected through the hospital information system and telephone follow-up.The patients were divided into two groups according to the Glu_(cv):group L(Glu_(cv)<29.8%,n=52)and group H(Glu_(cv)≥29.8%,n=74).The incidence of EAD,the highest value of CRP within 7 days,ICU time,and 30 day survival rate after surgery were recorded.Results Compared with group H,the incidence of EAD in group L was significantly lower(P<0.05),and the stay time in ICU was significantly shorter(P<0.05).There was no significant difference in the highest value of CRP and 30 day survival rate after surgery between the two groups.Conclusion The incidence of EAD in low Glu_(cv)group after liver transplantation is lower,and the length of stay in ICU is shorter.Glycemic coefficient of variation should be reduced to improve the prognosis during liver transplantation.