Levy M F, Greene L, Ramsay M A, Jennings L W, Ramsay K J, Meng J, Hein H A, Goldstein R M, Husberg B S, Gonwa T A, Klintmalm G B
Department of Transplant Services, Baylor University Medical Center, Dallas, TX 75246-2096, USA.
Crit Care Med. 2001 Jan;29(1):18-24. doi: 10.1097/00003246-200101000-00004.
We undertook this study to understand the factors at our transplant center that contribute to patients' return to the ICU after their liver transplant and their initial discharge from that unit. Patients who, after liver transplantation, fail discharge from the Intensive Care Unit (ICU) and must be readmitted to that unit may well utilize many more resources than those patients who are well enough to stay out of the ICU.
A retrospective review of a prospectively maintained liver transplant research database followed by a retrospective review of (a subgroup) patient charts and contemporaneous controls.
A large metropolitan tertiary care center and adult liver transplant center.
A total of 1,197 consecutive adult patients who underwent their initial liver transplantation from 1984 to 1996.
Readmission to the intensive care unit after adult liver transplantation and discharge from that unit.
Only recipient age, pretransplant synthetic function labs (protime and albumin), bilirubin levels, and intraoperative blood product requirements could be statistically linked to the group requiring ICU readmission. The primary etiology for ICU readmission was cardiopulmonary deterioration. Readmission was associated with significantly lower patient and graft survivals. A detailed review of 23 patients transplanted from October 1994 to June 1996 was made, with special emphasis on cardiopulmonary status (hemodynamics, respiratory variables, and chest radiograph findings). This subgroup was compared with 30 temporally matched controls who were not readmitted to the ICU. Intravascular fluid overload and lower inspiratory capacity were significant factors related to ICU readmission. Readmitted patients had a longer hospitalization with higher hospital charges than the control group.
We conclude that the most important means of preventing ICU readmission in liver transplantation patients is to optimize cardiopulmonary function and status. Close monitoring of fluid balance to avoid hypervolemia is essential. Readmitted patients have a greater resource utilization and have lower survival rates.
我们开展这项研究是为了了解在我们的移植中心，导致肝移植患者在首次从重症监护病房（ICU）出院后又返回该病房的因素。肝移植后未能从重症监护病房顺利出院且必须再次入院的患者，相比那些身体状况良好无需再入住ICU的患者，很可能会消耗更多的资源。
对一个前瞻性维护的肝移植研究数据库进行回顾性分析，随后对（一个亚组）患者病历及同期对照进行回顾性分析。
一个大型都市三级医疗中心及成人肝移植中心。
1984年至1996年间接受首次肝移植的1197例成年患者。
成人肝移植后再次入住重症监护病房及从该病房出院。
只有受者年龄、移植前肝功能实验室指标（凝血酶原时间和白蛋白）、胆红素水平以及术中血液制品需求量在统计学上与需要再次入住ICU的患者组相关。再次入住ICU的主要病因是心肺功能恶化。再次入院与患者及移植物存活率显著降低相关。对1994年10月至1996年6月期间接受移植的23例患者进行了详细分析，特别关注心肺状况（血流动力学、呼吸变量及胸部X线检查结果）。将该亚组与30例未再次入住ICU的同期匹配对照进行比较。血管内液体超负荷和较低的吸气能力是与再次入住ICU相关的重要因素。再次入院患者的住院时间更长，住院费用比对照组更高。
我们得出结论，预防肝移植患者再次入住ICU的最重要方法是优化心肺功能和状态。密切监测液体平衡以避免血容量过多至关重要。再次入院患者资源利用率更高，存活率更低。
