原位肝移植期间快速均匀再灌注作为再灌注综合征的危险因素

Rapid and homogeneous reperfusion as a risk factor for postreperfusion syndrome during orthotopic liver transplantation.

作者信息

Cordoví de Armas Lucas, Jiménez Paneque Rosa E, Gala López Boris, Rápalo Romero Edin Ismael, Añuez Castillo Ydriss, Vallongo Menéndez Marina Beatriz

机构信息

Serviço de Anestesiologia, Hospital Clínico Quirúrgico Heramanos Ameijeiras.

出版信息

Rev Bras Anestesiol. 2010 Mar-Apr;60(2):154-61, 88-92.

PMID:20485960

Abstract

BACKGROUND AND OBJECTIVES

The revascularization of the graft remains as a crucial instant of the orthotopic liver transplantation (OLT) surgical procedure. About a third of the recipients suffer the postreperfusion syndrome (PRS), a combination of hypothermia, metabolic disorders and cardiovascular instability potentially leading to cardiac arrest. The objective of this study was to evaluate the speed-quality (SQR) of the graft;s reperfusion as an independent predictor of PRS.

METHODS

All eligible patients receiving an OLT in our institution from 1987 to march 2009 were included. The adjusted OR for SQR-PRS association was obtained by means of logistic regression modeling including eight potential confounders.

RESULTS

The proportion of recipients suffering PRS was highest when the SQR was identified as good (75.8%) compared to those with middle or poor SQR; the relative risk comparing good SQR with poor SQR was 12.9 (CI 95%: 2.1-528.8). The adjusted OR was 132.9 (95% CI: 10.5-1688.6) when comparing good with bad SQR and 90.9 (95% CI: 13.8-645.2) when comparing good with intermediate SQR.

CONCLUSIONS

According to our results, SQR can be considered an unambiguous predictor of PRS.

摘要

背景与目的

移植物的血管再通仍然是原位肝移植（OLT）手术过程中的关键环节。约三分之一的受者会发生再灌注综合征（PRS），这是一种体温过低、代谢紊乱和心血管不稳定的综合征，有可能导致心脏骤停。本研究的目的是评估移植物再灌注的速度-质量（SQR）作为PRS的独立预测指标。

方法

纳入1987年至2009年3月在本机构接受OLT的所有符合条件的患者。通过包括八个潜在混杂因素的逻辑回归模型获得SQR与PRS关联的调整优势比。

结果

当SQR被判定为良好时，发生PRS的受者比例最高（75.8%），而SQR为中等或较差的受者比例较低；良好SQR与较差SQR相比的相对风险为12.9（95%置信区间：2.1-528.8）。良好SQR与较差SQR相比，调整后的优势比为132.9（95%置信区间：10.5-1688.6），良好SQR与中等SQR相比，调整后的优势比为90.9（95%置信区间：13.8-645.2）。