Lepere Victoria, Vanier Antoine, Loncar Yann, Lemoine Louis, Vaillant Jean Christophe, Monsel Antoine, Savier Eric, Coriat Pierre, Eyraud Daniel
Department of Anesthesiology and Reanimation, Assistance Publique-Hôpitaux de Paris (AP-HP), University Hospitals Pitié-Salpêtrière Charles-Foix, 43-87 Boulevard de l'Hôpital, 75013, Paris, France.
Department of Biostatistics, Sorbonne University, UPMC University, Paris 06, Paris, France.
BMC Anesthesiol. 2017 Jun 20;17(1):84. doi: 10.1186/s12871-017-0372-9.
Postoperative operative pulmonary complications (PPCs) after hepatic surgery are associated with increased length of hospital stays. Intraoperative blood transfusion, extensive resection and different comorbidities have been identified. Other parameters, like time of hepatic ischemia, have neither been clinically studied, though experimental studies show that hepatic ischemia can provide lung injury. The objective of this study was to determinate the risk factors of postoperative pulmonary complications (PPCs) after hepatic resection within 7 postoperative days.
Ninety-four patients consecutively who underwent elective hepatectomy between January and December 2013. Demographic data, pathological variables, and preoperative, intraoperative, and postoperative variables had been prospectively collected in a data base. The dependant variables studied were the occurrence of PPCs, defined before analysis of the data.
PPCs occurred in 32 (34%) patients. A multivariate analysis allowed identifying the risk factors for PPCs. On multivariate analysis, preoperative gamma-glutamyltransferase (GGT) elevation OR =5,12 [1,85-15,69] p = 0,002, liver ischemia duration OR = 1,03 [1,01-1,06] p = 0,01 and the intraoperative use of vasopressor OR = 4,40 [1,58-13,36] p = 0,006 were independently associated with PPCs. For every 10 min added in ischemia duration, the OR of the risk of PPCs was estimated to be 1.37 (CI = [1.08-1.81], p = 0.01).
Three risk factors for PPCs have been identified in a population undergoing liver resection: preoperative GGT elevation, ischemia duration and the intraoperative use of vasopressor. PPCs after liver surgery could be related to lung injury induced by liver ischemia reperfusion and not solely by direct infectious process. That could explain why factors influencing directly or indirectly liver ischemia were independently associated with PPCs.
肝脏手术后的术后肺部并发症（PPCs）与住院时间延长相关。术中输血、广泛切除以及不同的合并症已被确认。其他参数，如肝脏缺血时间，虽实验研究表明肝脏缺血可导致肺损伤，但尚未进行临床研究。本研究的目的是确定肝切除术后7天内术后肺部并发症（PPCs）的危险因素。
连续纳入2013年1月至12月期间接受择期肝切除术的94例患者。人口统计学数据、病理变量以及术前、术中和术后变量已前瞻性收集于数据库中。所研究的因变量为PPCs的发生情况，在数据分析前进行定义。
32例（34%）患者发生了PPCs。多因素分析确定了PPCs的危险因素。多因素分析显示，术前γ-谷氨酰转移酶（GGT）升高，OR = 5.12 [1.85 - 15.69]，p = 0.002；肝脏缺血持续时间，OR = 1.03 [1.01 - 1.06]，p = 0.01；术中使用血管加压药，OR = 4.40 [1.58 - 13.36]，p = 0.006，均与PPCs独立相关。缺血持续时间每增加10分钟，PPCs风险的OR估计为1.37（CI = [1.08 - 1.81]，p = 0.01）。
在接受肝切除的人群中确定了PPCs的三个危险因素：术前GGT升高、缺血持续时间和术中使用血管加压药。肝脏手术后的PPCs可能与肝脏缺血再灌注诱导的肺损伤有关，而不仅仅是直接的感染过程。这可以解释为什么直接或间接影响肝脏缺血的因素与PPCs独立相关。
