Sharma Ankur, Karna Sunaina Tejpal, Tandon Manish, Pandey Chandra Kant, Chaturvedi Ravindra, Vyas Varuna, Goel Akhil Dhanesh
Department of Anaesthesiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India.
Department of Anaesthesiology, Institute of Liver and Biliary Sciences, New Delhi, India.
Saudi J Anaesth. 2018 Jul-Sep;12(3):406-411. doi: 10.4103/sja.SJA_12_18.
The present study was designed to explore the utility of ultrasound-guided diaphragmatic thickness in the preoperative period in healthy controls scheduled for live-related donor hepatectomy and patients suffering from chronic liver disease scheduled for liver transplantation (LT) and its use as a predictor of postoperative weaning failure.
This prospective observational study was conducted in a tertiary health care center and 65 adult (18-70 years) participants (30 healthy liver donors and 35 liver transplant recipients) were enrolled for this study. Right diaphragmatic thickness of both donors and recipients was measured by B-mode ultrasound using a 10 MHz linear array transducer in the supine position in the operation theater just before induction of anesthesia. For subgroup analysis of the recipients, we further divided them into two groups - Group 1 (diaphragmatic thickness < 2 mm) and Group 2 (diaphragmatic thickness > 2 mm), and comparison was done for duration of mechanical ventilation. Intergroup comparison was made for duration of mechanical ventilation and various other parameters.
The sonographic measurement of diaphragm revealed that its thickness is decreased in patients with chronic liver disease patients (2.12 ± 0.54 mm) as compared to healthy donors (3.70 ± 0. 58 mm). On multiple logistic regression, higher duration of mechanical ventilation was associated with diaphragmatic thickness < 2 mm (Group 1 of recipients) (adjusted odds ratio 0.86; 95% confidence interval: 0.75-0.99; = 0.013) after adjusting for age, gender, and body mass index.
Diaphragmatic thickness is decreased in patients with chronic liver disease as compared to healthy liver donors. Preoperative measurement of ultrasound-guided right hemidiaphragm thickness can be used to predict weaning failure in patients undergoing LT. Other studies are needed to confirm these finding on different group of patients.
本研究旨在探讨超声引导下测量膈肌厚度在择期活体供肝肝切除术的健康对照者以及择期肝移植（LT）的慢性肝病患者术前的应用价值，及其作为术后脱机失败预测指标的作用。
本前瞻性观察性研究在一家三级医疗保健中心进行，纳入了65名成年（18 - 70岁）参与者（30名健康肝脏供体和35名肝移植受者）。在手术室麻醉诱导前，让供体和受者仰卧位，使用10 MHz线性阵列换能器通过B超测量其右侧膈肌厚度。对于受者的亚组分析，我们将他们进一步分为两组——第1组（膈肌厚度<2 mm）和第2组（膈肌厚度>2 mm），并比较两组机械通气时间。对机械通气时间和其他各种参数进行组间比较。
膈肌的超声测量显示，慢性肝病患者的膈肌厚度（2.12±0.54 mm）低于健康供体（3.70±0.58 mm）。在多因素逻辑回归分析中，在调整年龄、性别和体重指数后，机械通气时间延长与膈肌厚度<2 mm（受者第1组）相关（调整后的优势比为0.86；95%置信区间：0.75 - 0.99；P = 0.013）。
与健康肝脏供体相比，慢性肝病患者的膈肌厚度降低。术前超声引导下测量右侧半膈肌厚度可用于预测肝移植患者的脱机失败。需要其他研究在不同患者群体中证实这些发现。
