Department of Anesthesiology, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, 200433, China.
Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, 200433, China.
Asian J Surg. 2024 Jan;47(1):380-388. doi: 10.1016/j.asjsur.2023.09.016. Epub 2023 Sep 17.
Patients undergoing lung transplantation (LTx) often experience abnormal hypercapnia or hypocapnia. This study aimed to investigate the association between intraoperative PaCO and postoperative adverse outcomes in patients undergoing LTx.
We retrospectively reviewed the medical records of 151 patients undergoing LTx. Patients' demographics, perioperative clinical factors, and pre- and intraoperative PaCO data after reperfusion were collected and analyzed. Based on the PaCO levels, patients were classified into three groups: hypocapnia (≤35 mmHg), normocapnia (35.1-55 mmHg), and hypercapnia (>55 mmHg). Univariate and multivariable logistic regressions were used to identify independent risk factors for postoperative composite adverse events and in-hospital mortality.
Intraoperative hypercapnia occurred in 69 (45.7%) patients, and hypocapnia in 17 (11.2%). Patients with intraoperative PaCO of 35.1-45 mmHg showed a lower incidence of composite adverse events (53.3%) and mortality (6.2%) (P < 0.001). There was no significant difference in composite adverse events and mortality among preoperative PaCO groups (P > 0.05). Compared with intraoperative PaCO at 35.1-45 mmHg, the risk of composite adverse events in hypercapnia group increased: the adjusted OR was 3.07 (95% confidence interval [CI]: 1.36-6.94; P = 0.007). The risk of death was significantly higher in hypocapnia group than normocapnia group, the adjusted OR was 7.69 (95% CI: 1.68-35.24; P = 0.009). Over ascending ranges of PaCO, PaCO at 55.1-65 mmHg had the strongest association with composite adverse events, the adjusted OR was 6.40 (95% CI: 1.18-34.65; P = 0.031).
These results demonstrate that intraoperative hypercapnia independently predicts postoperative adverse outcomes in patients undergoing LTx. Intraoperative hypocapnia shows predictive value for postoperative in-hospital mortality in LTx.
接受肺移植（LTx）的患者常经历异常高碳酸血症或低碳酸血症。本研究旨在探讨 LTx 患者术中 PaCO 与术后不良结局的关系。
我们回顾性分析了 151 例行 LTx 患者的病历。收集并分析了患者的人口统计学、围手术期临床因素以及再灌注后术前和术中的 PaCO 数据。根据 PaCO 水平，患者被分为三组：低碳酸血症（≤35mmHg）、正常碳酸血症（35.1-55mmHg）和高碳酸血症（>55mmHg）。采用单因素和多因素逻辑回归分析确定术后复合不良事件和院内死亡的独立危险因素。
术中高碳酸血症发生在 69 例（45.7%）患者中，低碳酸血症发生在 17 例（11.2%）患者中。术中 PaCO 为 35.1-45mmHg 的患者复合不良事件（53.3%）和死亡率（6.2%）发生率较低（P<0.001）。术前 PaCO 组之间的复合不良事件和死亡率无显著差异（P>0.05）。与术中 PaCO 在 35.1-45mmHg 相比，高碳酸血症组复合不良事件的风险增加：调整后的 OR 为 3.07（95%可信区间[CI]：1.36-6.94；P=0.007）。低碳酸血症组的死亡风险明显高于正常碳酸血症组，调整后的 OR 为 7.69（95%CI：1.68-35.24；P=0.009）。随着 PaCO 的逐渐升高，PaCO 在 55.1-65mmHg 时与复合不良事件的相关性最强，调整后的 OR 为 6.40（95%CI：1.18-34.65；P=0.031）。
这些结果表明，术中高碳酸血症独立预测 LTx 患者术后不良结局。术中低碳酸血症对 LTx 患者术后院内死亡率具有预测价值。
