Shiba Hiroaki, Ishii Yuji, Ishida Yuichi, Wakiyama Shigeki, Sakamoto Taro, Ito Ryusuke, Gocho Takeshi, Uwagawa Tadashi, Hirohara Shoichi, Kita Yoshiaki, Misawa Takeyuki, Yanaga Katsuhiko
Department of Surgery, Jikei University School of Medicine, Minato, Tokyo, Japan.
J Hepatobiliary Pancreat Surg. 2009;16(1):69-74. doi: 10.1007/s00534-008-0006-1. Epub 2008 Dec 16.
In perioperative management after hepatectomy, some patients require fresh frozen plasma (FFP) to treat coagulopathy associated with blood loss. However, several studies have suggested a correlation between blood products and pulmonary complications or surgical-site infection (SSI).
The subjects were 99 patients who underwent hepatectomy for hepatocellular carcinoma without plasma exchange for postoperative liver failure in the Department of Surgery, Jikei University Hospital, between January 2000 and December 2006. We investigated the association of 16 factors including age; gender; preoperative ICG(R15); type of resection; concomitant resection of other digestive organs; duration of operation; blood loss; hepatitis virus status; postoperative minimum platelet count, maximum serum total bilirubin (max T-Bil), minimum serum albumin, or minimum prothrombin time; and the dose of red-blood-cell concentration (RC), FFP, platelet concentration, or albumin given in relation to postoperative pulmonary complications and SSI.
In univariate analysis, pulmonary complications were correlated with gender (P = 0.012), max T-Bil (P = 0.043), dose of RC given (P = 0.007), dose of FFP given (P < 0.001), and dose of albumin given (P < 0.001). In multivariate analysis, pulmonary complications were correlated with FFP given (P = 0.031) and albumin given (P = 0.020), while the incidence of SSI was not correlated with any factors.
Excessive FFP and albumin administration may cause pulmonary complications after hepatectomy.
在肝切除术后的围手术期管理中，一些患者需要新鲜冰冻血浆（FFP）来治疗与失血相关的凝血病。然而，多项研究表明血液制品与肺部并发症或手术部位感染（SSI）之间存在关联。
研究对象为2000年1月至2006年12月期间在日本庆应义塾大学医院外科接受肝细胞癌肝切除术且未进行血浆置换以治疗术后肝衰竭的99例患者。我们调查了16个因素之间的关联，这些因素包括年龄、性别、术前吲哚菁绿滞留率（ICG[R15]）、切除类型、其他消化器官的联合切除、手术持续时间、失血量、肝炎病毒状态、术后最低血小板计数、最高血清总胆红素（max T - Bil）、最低血清白蛋白或最低凝血酶原时间，以及给予的红细胞浓缩液（RC）、FFP、血小板浓缩液或白蛋白的剂量与术后肺部并发症和SSI的关系。
在单因素分析中，肺部并发症与性别（P = 0.012）、max T - Bil（P = 0.043）、给予的RC剂量（P = 0.007）、给予的FFP剂量（P < 0.001）和给予的白蛋白剂量（P < 0.001）相关。在多因素分析中，肺部并发症与给予的FFP（P = 0.031）和给予的白蛋白（P = 0.020）相关，而SSI的发生率与任何因素均无关联。
肝切除术后过量给予FFP和白蛋白可能导致肺部并发症。
