Juang S-E, Huang C-E, Chen C-L, Wang C-H, Huang C-J, Cheng K-W, Wu S-C, Shih T-H, Yang S-C, Wong Z-W, Jawan B, Lee Y-E
Department of Anesthesiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan.
Liver Transplantation Program and Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
Transplant Proc. 2016 May;48(4):1022-4. doi: 10.1016/j.transproceed.2015.11.018.
Hyperkalemia, defined as a serum potassium level higher than 5 mEq/L, is common in the liver transplantation setting. Severe hyperkalemia may induce fatal cardiac arrhythmias; therefore, it should be monitored and treated accordingly. The aim of the current retrospective study is to evaluate and indentify the predictive risk factors of hyperkalemia during living-donor liver transplantation (LDLT).
Four hundred eighty-seven adult LDLT patients were included in the study. Intraoperative serum potassium levels were monitored at least five times during LDLT; patients with a potassium level higher than 5 mEq/L were included in group 1, and the others with normokalemia in group 2. Patients' categorical characteristics and intraoperative numeric variables with a P value <.1 were selected into a multiple binary logistic regression model. In multivariate analysis, a P value of <.05 is regarded as a risk factor in the development of hyperkalemia.
Fifty-one of 487 (10.4%) patients had hyperkalemia with a serum potassium level higher than 5.0 mEq/L during LDLT. Predictive factors with P < .1 in univariate analysis (Table 1), such as anesthesia time, preoperative albumin level, Model for End-stage Liver Disease score, preoperative bilirubin level, amount of blood loss, red blood cell (RBC) and fresh frozen plasma transfused, 5% albumin administered, hemoglobin at the end of surgery, and the amount of furosemide used, were further analyzed by multivariate binary regression. Results show that the anesthesia time, preoperative serum albumin level, and RBC count are determinant risk factors in the development of the hyperkalemia in our LDLT serials.
Prolonged anesthesia time, preoperative serum albumin level, and intraoperative RBC transfusion are three determinant factors in the development of intraoperative hyperkalemia, and close monitoring of serum potassium levels in patients with abovementioned risk factors are recommended.
高钾血症定义为血清钾水平高于5 mEq/L，在肝移植患者中很常见。严重的高钾血症可能诱发致命的心律失常；因此，应进行监测并相应治疗。本回顾性研究的目的是评估和识别活体肝移植（LDLT）期间高钾血症的预测风险因素。
本研究纳入了487例成年LDLT患者。LDLT期间术中血清钾水平至少监测5次；血清钾水平高于5 mEq/L的患者纳入第1组，其余血钾正常的患者纳入第2组。将P值<0.1的患者分类特征和术中数值变量纳入多元二元逻辑回归模型。在多变量分析中，P值<0.05被视为高钾血症发生的危险因素。
487例患者中有51例（10.4%）在LDLT期间出现血清钾水平高于5.0 mEq/L的高钾血症。单变量分析中P<0.1的预测因素（表1），如麻醉时间、术前白蛋白水平、终末期肝病模型评分、术前胆红素水平、失血量、输注的红细胞（RBC）和新鲜冰冻血浆、给予的5%白蛋白、手术结束时的血红蛋白以及使用的呋塞米量，通过多元二元回归进一步分析。结果表明，麻醉时间、术前血清白蛋白水平和RBC计数是我们LDLT系列中高钾血症发生的决定性危险因素。
麻醉时间延长、术前血清白蛋白水平和术中RBC输血是术中高钾血症发生的三个决定性因素，建议对有上述危险因素的患者密切监测血清钾水平。
