术前和术中临床分析有助于活体肝移植术后成功的手术室拔管：一项回顾性观察队列研究。
Analysis of pre- and intraoperative clinical for successful operating room extubation after living donor liver transplantation: a retrospective observational cohort study.
机构信息
Department of Anesthesiology and Pain medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea.
Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
出版信息
BMC Anesthesiol. 2019 Jun 28;19(1):112. doi: 10.1186/s12871-019-0781-z.
BACKGROUND
Early extubation after liver transplantation is safe and accelerates patient recovery. Patients with end-stage liver disease undergo sarcopenic changes, and sarcopenia is associated with postoperative morbidity and mortality. We investigated the impact of core muscle mass on the feasibility of immediate extubation in the operating room (OR) after living donor liver transplantation (LDLT).
METHODS
A total of 295 male adult LDLT patients were retrospectively reviewed between January 2011 and December 2017. In total, 40 patients were excluded due to emergency surgery or severe encephalopathy. A total of 255 male LDLT patients were analyzed in this study. According to the OR extubation criteria, the study population was classified into immediate and conventional extubation groups (39.6 vs. 60.4%). Psoas muscle area was estimated using abdominal computed tomography and normalized by height squared (psoas muscle index [PMI]).
RESULTS
There were no significant differences in OR extubation rates among the five attending transplant anesthesiologists. The preoperative PMI correlated with respiratory performance. The preoperative PMI was higher in the immediate extubation group than in the conventional extubation group. Potentially significant perioperative factors in the univariate analysis were entered into a multivariate analysis, in which preoperative PMI and intraoperative factors (i.e., continuous renal replacement therapy, significant post-reperfusion syndrome, and fresh frozen plasma transfusion) were associated with OR extubation. The duration of ventilator support and length of intensive care unit stay were shorter in the immediate extubation group than in the conventional extubation group, and the incidence of pneumonia and early allograft dysfunction were also lower in the immediate extubation group.
CONCLUSIONS
Our study could improve the accuracy of predictions concerning immediate post-transplant extubation in the OR by introducing preoperative PMI into predictive models for patients who underwent elective LDLT.
背景
肝移植术后早期拔管是安全的，并能加速患者康复。终末期肝病患者会发生肌肉减少症改变，而肌肉减少症与术后发病率和死亡率有关。我们研究了核心肌肉质量对活体供肝移植（LDLT）后手术室（OR）即刻拔管可行性的影响。
方法
回顾性分析 2011 年 1 月至 2017 年 12 月期间 295 例成年男性 LDLT 患者的资料。共有 40 例患者因急诊手术或严重肝性脑病而被排除。本研究共分析了 255 例男性 LDLT 患者。根据 OR 拔管标准，将研究人群分为即刻拔管组和常规拔管组（39.6%比 60.4%）。使用腹部 CT 估计腰大肌面积，并通过身高平方进行标准化（腰大肌指数[PMI]）。
结果
5 位肝移植麻醉医师的 OR 拔管率无显著差异。术前 PMI 与呼吸功能相关。即刻拔管组的术前 PMI 高于常规拔管组。单因素分析中有潜在意义的围手术期因素被纳入多因素分析，其中术前 PMI 和术中因素（即持续肾脏替代治疗、明显再灌注综合征和新鲜冷冻血浆输注）与 OR 拔管相关。即刻拔管组的呼吸机支持时间和重症监护病房住院时间均短于常规拔管组，且即刻拔管组肺炎和早期移植物功能障碍的发生率也较低。
结论
本研究通过将术前 PMI 引入预测模型，可为接受选择性 LDLT 的患者提供更准确的 OR 即刻移植后拔管预测。
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