Aydınlı Bahar, Karadeniz Ümit, Demir Aslı, Güçlü Çiğdem Yıldırım, Kazancı Dilek, Koçulu Rabia, Haytural Candan, Özgök Ayşegül, Bostancı Erdal Birol, Zorlu Ali
Clinic of Anaesthesia, Mersin State Hospital, Mersin, Turkey.
Clinic of Anaesthesiology and Reanimation, Türkiye Yüksek İhtisas Training and Research Hospital, Ankara, Turkey.
Turk J Anaesthesiol Reanim. 2016 Jun;44(3):128-33. doi: 10.5152/TJAR.2016.32657. Epub 2016 Jun 1.
To evaluate the factors that affects the postperfusion syndrome in cadaveric liver transplantations and the effect of the postperfusion syndrome on discharge from the hospital.
Patients who underwent cadaveric liver transplantations between 2007 and 2013 were scanned retrospectively. Intraoperative anaesthesia records, intensive care unit follow-up forms and discharge reports were examined from patient files. Overall, 43 patients having complete data were included in the study. The postperfusion syndrome is defined as asystoli or a decrease in mean arterial pressure of more than 30%, which occurred in the first 5 min of reperfusion and continued for 1 min. Patients were divided into two groups: those who had the postperfusion syndrome and those who did not.
The number of patients who had the postperfusion syndrome was 25 of 43 (58.1%). The MELD score of patients without the postperfusion syndrome was calculated as 16.9±3.2 and that of patients with the postperfusion syndrome was 19.7±3.6. A statistically significant relationship was detected between the postperfusion syndrome occurrence and a high MELD score (p=0.013). The diastolic blood pressure just before reperfusion was statistically lower in the group with the postperfusion syndrome than in the other group (p=0.023, 50±8 vs. 58±11). According to the logistic regression analysis, the MELD score and the decrease in diastolic blood pressure before reperfusion were defined as independent predictive factors.
According to the study, the ratio for having the postperfusion syndrome was found to be 58.1%. The independent predictor factors affecting the postperfusion syndrome were detected as the MELD score and the decrease in diastolic blood pressure before reperfusion. The postperfusion syndrome during orthotropic liver transplantation is an important issue for anaesthesiologists. The awareness of the related factors with the postperfusion syndrome may help in the development of various preventive strategies.
评估影响尸体肝移植灌注后综合征的因素以及灌注后综合征对出院的影响。
回顾性扫描2007年至2013年间接受尸体肝移植的患者。从患者病历中检查术中麻醉记录、重症监护病房随访表格和出院报告。总体而言，43例数据完整的患者纳入研究。灌注后综合征定义为再灌注开始后5分钟内出现心脏停搏或平均动脉压下降超过30%，且持续1分钟。患者分为两组：发生灌注后综合征的患者和未发生灌注后综合征的患者。
43例患者中有25例（58.1%）发生灌注后综合征。未发生灌注后综合征患者的终末期肝病模型（MELD）评分为16.9±3.2，发生灌注后综合征患者的MELD评分为19.7±3.6。灌注后综合征的发生与高MELD评分之间存在统计学显著相关性（p = 0.013）。灌注后综合征组再灌注前的舒张压在统计学上低于另一组（p = 0.023，50±8 vs. 58±11）。根据逻辑回归分析，MELD评分和再灌注前舒张压的下降被确定为独立预测因素。
根据该研究，发现发生灌注后综合征的比例为58.1%。影响灌注后综合征的独立预测因素被确定为MELD评分和再灌注前舒张压的下降。原位肝移植期间的灌注后综合征是麻醉医生面临的一个重要问题。了解与灌注后综合征相关的因素可能有助于制定各种预防策略。
