Struck Manuel Florian, Werdehausen Robert, Kirsten Holger, Gössmann Holger, Veelken Rhea, van Bömmel Florian, Stehr Sebastian, Denecke Timm, Ebel Sebastian
Department of Anesthesiology and Intensive Care Medicine, University Hospital Leipzig, Liebigstr. 20, 04103 Leipzig, Germany.
Institute for Medical Statistics, Informatics and Epidemiology, Medical Faculty, University of Leipzig, 04107 Leipzig, Germany.
Cancers (Basel). 2023 Jul 25;15(15):3776. doi: 10.3390/cancers15153776.
Percutaneous hepatic melphalan perfusion (chemosaturation) in patients with liver metastases is known to be associated with procedure-related hemodynamic depression and coagulation impairment, which may cause bleeding complications and/or a prolonged intensive care unit length of stay (ICU LOS). We retrospectively analyzed possible predictive factors for bleeding complications and an ICU LOS > 1 d in a cohort of 31 patients undergoing 90 chemosaturation procedures. Using a multivariable mixed-model approach, we identified the amount of perioperative fluid volume (OR 12.0, 95% CI 2.3-60.0, = 0.003) and protamine (OR 0.065, 95% CI 0.007-0.55, = 0.012) to be associated with bleeding complications. Furthermore, the amount of perioperative fluid volume was associated with an ICU LOS > 1 d (OR 5.2, 95% CI 1.4-19.0, = 0.011). Heparin dosage, melphalan dosage, extracorporeal circulation time, and noradrenaline dosage had no significant effects on outcomes. Protamine use was not associated with anaphylactic or thromboembolic complications. Despite the limited sample size, these results suggest a restrictive perioperative fluid regime to be beneficial, and support the use of protamine for heparin reversal after chemosaturation procedures. Further prospective randomized trials are needed to confirm these findings.
已知肝转移患者经皮肝美法仑灌注（化学饱和法）与手术相关的血流动力学抑制和凝血功能障碍有关，这可能导致出血并发症和/或延长重症监护病房住院时间（ICU LOS）。我们回顾性分析了31例接受90次化学饱和手术患者队列中出血并发症和ICU LOS>1天的可能预测因素。使用多变量混合模型方法，我们确定围手术期液体量（OR 12.0，95%CI 2.3 - 60.0，P = 0.003）和鱼精蛋白（OR 0.065，95%CI 0.007 - 0.55，P = 0.012）与出血并发症相关。此外，围手术期液体量与ICU LOS>1天相关（OR 5.2，95%CI 1.4 - 19.0，P = 0.011）。肝素剂量、美法仑剂量、体外循环时间和去甲肾上腺素剂量对结局无显著影响。使用鱼精蛋白与过敏或血栓栓塞并发症无关。尽管样本量有限，但这些结果表明限制围手术期液体管理有益，并支持在化学饱和手术后使用鱼精蛋白进行肝素逆转。需要进一步的前瞻性随机试验来证实这些发现。
