Lee Serin, Sa Gye Jeol, Kim Stephanie Youna, Park Chul Soo
Department of Anesthesiology and Pain Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea.
Korean J Anesthesiol. 2014 Aug;67(2):103-9. doi: 10.4097/kjae.2014.67.2.103. Epub 2014 Aug 26.
Prolonged mechanical ventilation after liver transplantation has been associated with deleterious clinical outcomes, so early tracheal extubation posttransplant is now increasing. However, there is no universal clinical criterion for predicting early extubation in living-donor liver transplantation (LDLT). We investigated specific predictors of early extubation after LDLT.
Perioperative data of adult patients undergoing LDLT were reviewed. "Early" extubation was defined as tracheal extubation in the operating room or intensive care unit (ICU) within 1 h posttransplant, and we divided patients into early extubation (EX) and non-EX groups. Potentially significant (P < 0.10) perioperative variables from univariate analyses were entered into multivariate logistic regression analyses. Individual cut-offs of the predictors were calculated by area under the receiver operating characteristic curve (AUC) analysis.
Of 107 patients, 66 (61.7%) were extubated early after LDLT. Patients in the EX group showed shorter stays in the hospital and ICU and lower incidences of reoperation, infection, and vascular thrombosis. Preoperatively, model for end-stage liver disease score, lung disease, hepatic encephalopathy, ascites, and intraoperatively, surgical time, transfusion of packed red blood cell (PRBC), urine output, vasopressors, and last measured serum lactate were associated with early extubation (P < 0.05). After multivariate analysis, only PRBC transfusion of ≤ 7.0 units and last serum lactate of ≤ 8.2 mmol/L were selected as predictors of early extubation after LDLT (AUC 0.865).
Intraoperative serum lactate and blood transfusion were predictors of posttransplant early extubation. Aggressive efforts to ameliorate intraoperative circulatory issues would facilitate successful early extubation after LDLT.
肝移植后长时间机械通气与不良临床结局相关，因此目前移植后早期气管拔管的情况日益增多。然而，在活体肝移植（LDLT）中，尚无预测早期拔管的通用临床标准。我们研究了LDLT后早期拔管的特定预测因素。
回顾了接受LDLT的成年患者的围手术期数据。“早期”拔管定义为移植后1小时内在手术室或重症监护病房（ICU）进行气管拔管，我们将患者分为早期拔管（EX）组和非EX组。单因素分析中具有潜在显著性（P < 0.10）的围手术期变量被纳入多因素逻辑回归分析。通过受试者操作特征曲线（AUC）分析计算预测因素的个体临界值。
107例患者中，66例（61.7%）在LDLT后早期拔管。EX组患者的住院和ICU停留时间较短，再次手术、感染和血管血栓形成的发生率较低。术前，终末期肝病模型评分、肺部疾病、肝性脑病、腹水，以及术中，手术时间、浓缩红细胞（PRBC）输注量、尿量、血管升压药和最后测量的血清乳酸水平与早期拔管相关（P < 0.05）。多因素分析后，仅PRBC输注量≤7.0单位和最后血清乳酸水平≤8.2 mmol/L被选为LDLT后早期拔管的预测因素（AUC 0.865）。
术中血清乳酸水平和输血是移植后早期拔管的预测因素。积极努力改善术中循环问题将有助于LDLT后成功早期拔管。
