Kim Sung-Hoon, Moon Young-Jin, Lee Sooho, Jeong Sung-Moon, Song Jun-Gol, Hwang Gyu-Sam
Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
Liver Transpl. 2016 Jul;22(7):956-67. doi: 10.1002/lt.24415.
Hemodynamic perturbation during hepatic graft reperfusion in patients undergoing liver transplantation (LT) is challenging and is frequently accompanied by bradyarrhythmia and even asystole. However, detailed data on electrocardiographic (ECG) changes during reperfusion are almost nonexistent, although the correct diagnosis by record is important for the treatment. We aimed to identify ECG rhythm disturbances during graft reperfusion and to investigate risk factors and outcomes. Data from 1065 consecutive patients who underwent adult LT were analyzed. The incidence, type, and detailed characteristics of ECG changes immediately after graft reperfusion were assessed using an electronically archived intraoperative ECG database. We analyzed risk factors, postoperative outcomes including major cardiovascular events, 30-day and 1-year mortalities of recipients based on the occurrence of atrioventricular (AV) block, and asystole during reperfusion. The typical pattern of postreperfusion bradyarrhythmia was progressive PR interval prolongation until a Mobitz type 1 AV block occurred. The overall incidence of AV block was 5.0% (53/1065), and 30.2% of them (16/53) had initiated as AV block and then progressed into ventricular asystole. Fulminant hepatic failure was a significant predictor for occurrence of AV block (odds ratio [OR], 7.20; 95% confidence interval, 3.38-15.32; P < 0.001). Patients with AV block showed significantly higher incidence of postoperative major cardiovascular events (P < 0.001) and 30-day mortality (P = 0.002) than those without AV block, whereas the 1-year mortality was not different between the 2 groups (P = 0.10). The postreperfusion asystole was consistently preceded by a Mobitz type 1 AV block. The occurrence of AV block and asystole appears to be an important prognosticator. Therefore, maintaining an optimal range of physiological status and gradual unclamping of the vena cava to avoid sudden atrial distension are recommended in high-risk patients during reperfusion period. Liver Transplantation 22 956-967 2016 AASLD.
肝移植（LT）患者肝移植再灌注期间的血流动力学扰动具有挑战性，且常伴有缓慢性心律失常甚至心脏停搏。然而，尽管通过记录进行正确诊断对治疗很重要，但关于再灌注期间心电图（ECG）变化的详细数据几乎不存在。我们旨在识别移植再灌注期间的ECG节律紊乱，并调查危险因素和预后情况。分析了1065例连续接受成人LT患者的数据。使用电子存档的术中ECG数据库评估移植再灌注后立即出现的ECG变化的发生率、类型和详细特征。我们基于再灌注期间房室（AV）阻滞和心脏停搏的发生情况，分析了危险因素、包括主要心血管事件在内的术后结局、受者的30天和1年死亡率。再灌注后缓慢性心律失常的典型模式是PR间期逐渐延长直至发生莫氏I型AV阻滞。AV阻滞的总体发生率为5.0%（53/1065），其中30.2%（16/53）最初为AV阻滞，随后进展为心室停搏。暴发性肝衰竭是AV阻滞发生的重要预测因素（比值比[OR]，7.20；95%置信区间，3.38 - 15.32；P < 0.001）。与无AV阻滞的患者相比，有AV阻滞的患者术后主要心血管事件的发生率（P < 0.001）和30天死亡率（P = 0.002）显著更高，而两组的1年死亡率无差异（P = 0.10）。再灌注后心脏停搏之前始终会出现莫氏I型AV阻滞。AV阻滞和心脏停搏的发生似乎是一个重要的预后指标。因此，建议在再灌注期间对高危患者维持生理状态的最佳范围，并逐渐松开腔静脉以避免心房突然扩张。《肝脏移植》2016年第22卷956 - 967页 美国肝脏病研究协会
