影响肝移植术后早期拔管的危险因素分析

Analysis of risk factors affecting early extubation after liver transplantation

目的肝移植术后延迟拔管原因不明确,本研究旨在开发一种预测影响肝移植术后早期拔管危险因素的风险模型,为提高肝移植患者早期拔除气管插管提供依据。方法回顾性分析安徽医科大学第一附属医院器官移植中心2018年1月至2021月5月收治的93例成人肝移植患者资料。根据术后24小时是否拔除气管插管分为早期拔管组(58例)和延迟拔管组(35例)。通过单因素和Logistic多因素分析出影响患者早期拔管的因素。结果对影响肝移植术后患者早期拔管因素进行单因素和logistic多因素分析,评估得出术前Child-Pugh评分和手术时间是影响肝移植术后患者早期拔管的独立危险因素,术前Child-Pugh评分OR 1.542(95%CI 1.029~2.309),P=0.036,手术时间OR 2.059(95%CI 1.160~3.653),P=0.014。由术前Child-Pugh评分和手术时间组成模型和常用的肝移植患者的严重程度评分进行ROC分析,模型AUC 0.791;术前Child-Pugh评分AUC 0.743,术前MELD评分AUC 0.709,与这两个评分相比,预测模型在预测肝移植术后早期拔管风险方面显示出更好的辨别力。延迟拔管组的ICU住院时间,总住院时间和总费用明显高于早期拔管组,P<0.05有统计学差异。随访至术后28天,生存分析采用Kaplan-Meier曲线,Log-rank检验χ^(2)=2.692,P=0.101>0.05,两组差异无统计学意义。结论术前Child-Pugh评分和手术时间是影响肝移植术后早期拔管的独立影响因素。延迟拔管组ICU住院时间,总住院时间和总费用高于早期拔管组,但不影响肝移植术后患者的28天死亡率。可以帮助临床医生早期识别高危患者,并为临床治疗策略提供参考。

Objective The reasons for delayed extubation after liver transplantation are unclear,and this study aimed to develop a risk model to predict risk factors affecting early extubation after liver transplantation to provide a basis for improving early extubation of tracheal intubation in liver transplant patients.Methods The data of 93 adult liver transplant patients admitted to the Organ Transplantation Center of the First Affiliated Hospital of Anhui Medical University from January 2018 to May 2021 were retrospectively analyzed.They were divided into early extubation group(58 cases)and delayed extubation group(35 cases)according to whether the tracheal intubation was removed 24 hours after surgery.Factors influencing early extubation of patients were analyzed by univariate and logistic multifactorial analysis.Results Univariate and logistic multifactor analysis of factors affecting early extubation in patients after liver transplantation assessed that preoperative Child-Pugh score and operative time were independent risk factors affecting early extubation in patients after liver transplantation,preoperative Child-Pugh score OR 1.542(95%CI 1.029-2.309),P=0.036,OR for operative time 2.059(95%CI 1.160 to 3.653),P=0.014.ROC analysis consisting of preoperative Child-Pugh score and operative time for model and commonly used severity scores for liver transplant patients,model AUC 0.791;preoperative Child-Pugh score AUC 0.743,preoperative MELD score AUC 0.709,the predictive model showed better discrimination in predicting the risk of early extubation after liver transplantation compared to these two scores.The ICU length of stay,total length of stay and total cost were significantly higher in the delayed extubation group than in the early extubation group,with a statistically significant difference at P0.05.Follow-up to 28 days postoperatively,survival analysis was performed using Kaplan-Meier curve,Log-rank testχ^(2)=2.692,P=0.1010.05,and the difference between the two groups was not statistically significant.Conclusion Preoperative Child-Pugh score and operation time were independent influencing factors on early extubation after liver transplantation.The ICU length of stay,total length of stay and total cost were higher in the delayed extubation group than in the early extubation group,but did not affect the 28-day mortality rate of patients after liver transplantation.It can help clinicians to identify high-risk patients early and provide reference for clinical treatment strategy.