Park C, Kim D, Choi J, Kim E
Department of Anesthesiology and Pain Medicine, College of Medicine, Catholic University of Korea, Seoul, Korea.
Transplant Proc. 2010 Nov;42(9):3612-6. doi: 10.1016/j.transproceed.2010.06.039.
Prolonged mechanical ventilation (PMV), a common clinical manifestation, may result in fatal outcomes after living donor liver transplantation (LDLT). Although hyponatremia contributes to neurologic alterations in association with PMV, the effects of acute changes in hyponatremia during LDLT have not been well studied. We sought to determine whether an acute change in hyponatremia during surgery might be a risk factor for PMV after LDLT. Perioperative data were retrospectively collected from 381 patients who underwent LDLT from January 2000 to December 2008. PMV was defined as the need for ≥24 hours of mechanical ventilation within the first postoperative week. Using multivariate logistic regression a simple comparison of perioperative variables between the PMV group and the non-PMV group yielded a predictive model to establish PMV. Thirty-seven patients (9.7%) experienced PMV after LDLT. Intraoperative changes in blood sodium were associated with postoperative PMV; however, the relationship was limited to patients with preoperative hyponatremia. Patients with PMV showed lower survival rates than those without PMV (56.3% vs 86.3%; P <.001). A multivariate analysis revealed that preoperative hepatic encephalopathy, hypotension during surgery (more than 3 bowls), and intraoperative changes in hyponatremia were predictive of PMV. Among the hyponatremia change subgroups, only a severe intraoperative change (≥10 mEq/L) was associated with PMV occurrence (odds ratio, 5.85; 95% confidence interval, 1.62 to 21.20, P = .007). In conclusion, a severe intraoperative change in hyponatremia was a risk factor for PMV in the immediate period after LDLT.
长期机械通气（PMV）是一种常见的临床表现，在活体肝移植（LDLT）后可能导致致命后果。尽管低钠血症与PMV相关会导致神经功能改变，但LDLT期间低钠血症急性变化的影响尚未得到充分研究。我们试图确定手术期间低钠血症的急性变化是否可能是LDLT后发生PMV的危险因素。回顾性收集了2000年1月至2008年12月接受LDLT的381例患者的围手术期数据。PMV定义为术后第一周内需要机械通气≥24小时。通过多因素逻辑回归，对PMV组和非PMV组围手术期变量进行简单比较，得出一个预测模型来确定PMV。37例患者（9.7%）在LDLT后发生了PMV。术中血钠变化与术后PMV相关；然而，这种关系仅限于术前有低钠血症的患者。发生PMV的患者生存率低于未发生PMV的患者（56.3%对86.3%；P<.001）。多因素分析显示，术前肝性脑病、手术期间低血压（超过3次）和术中低钠血症变化可预测PMV。在低钠血症变化亚组中，只有严重的术中变化（≥10 mEq/L）与PMV发生相关（比值比，5.85；95%置信区间，1.62至21.20，P=.007）。总之，术中低钠血症的严重变化是LDLT后短期内发生PMV的危险因素。
