Luo Qingyong, Zhang Yu, Gu Shiyao, Liu Li, Zeng Si, Lei Qian
Department of Anesthesiology, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, 610072, China.
School of Medical and Life Sciences, Chengdu University of Traditional Chinese Medicine, Chengdu, 610072, China.
BMC Anesthesiol. 2025 Jul 17;25(1):352. doi: 10.1186/s12871-025-03215-7.
High-altitude adaptation (HAA), induced by chronic hypoxia, has clinically significant cardioprotective effects; however, its impact on postoperative pulmonary complications (PPCs) in patients undergoing liver resection remains uncertain.
We conducted a single-center prospective matched cohort study enrolling 292 consecutive patients undergoing elective liver resection. Patients were divided into two groups based on their long-term residential altitude: high-altitude group (≥ 1500 m) and plain group (< 1500 m). Propensity score matching (1:2 ratio) was applied to control for confounding factors, including demographic variables, clinical characteristics, preoperative oxygen saturation, ARISCAT score, and surgical factors. The primary outcome was the incidence of PPCs within 7 days after surgery. Secondary outcomes included the severity of PPCs, surgical complication grading, and length of hospital stay. Statistical analysis was performed using R software and SPSS 22.0.
After matching, 212 patients were included in the analysis. The incidence of PPCs within 7 days postoperatively in the high-altitude group was significantly lower than that in the plain group (61.5% vs. 76.1%, RR 0.80, 95% CI 0.66-0.98, P = 0.024). Furthermore, the high-altitude group showed milder complication severity and a shorter hospital stay (6 [4-8] vs. 7 [5-11] days, P = 0.005). Multivariate logistic regression analysis showed that HAA was an independent protective factor against PPCs (OR 0.31, 95% CI 0.12-0.83, P = 0.020). Further exploratory analysis revealed that during hepatic pedicle clamping, blood glucose levels remained more stable in the high-altitude group ([9.30 [7.25-11.90] vs. 10.95 [7.90-14.00] mmol/L, P < 0.001), with lower lactate accumulation after multiple clamps (1.55 [1.10-2.17] vs. 1.70 [1.10-2.50] mmol/L, P = 0.042).
HAA may reduce the incidence and severity of PPCs after liver resection, potentially due to enhanced metabolic stability associated with chronic hypoxia in high-altitude residents.
This study is registered with ChiCTR (ID: ChiCTR2200061915), registered on July 11, 2022.
慢性缺氧诱导的高原适应（HAA）具有临床上显著的心脏保护作用；然而，其对肝切除患者术后肺部并发症（PPCs）的影响仍不确定。
我们进行了一项单中心前瞻性匹配队列研究，纳入292例连续接受择期肝切除的患者。根据患者长期居住海拔将其分为两组：高原组（≥1500米）和平原组（<1500米）。采用倾向评分匹配（1:2比例）来控制混杂因素，包括人口统计学变量、临床特征、术前血氧饱和度、ARISCAT评分和手术因素。主要结局是术后7天内PPCs的发生率。次要结局包括PPCs的严重程度、手术并发症分级和住院时间。使用R软件和SPSS 22.0进行统计分析。
匹配后，212例患者纳入分析。高原组术后7天内PPCs的发生率显著低于平原组（61.5%对76.1%，RR 0.80，95%CI 0.66 - 0.98，P = 0.024）。此外，高原组并发症严重程度较轻，住院时间较短（6[4 - 8]天对7[5 - 11]天，P = 0.005）。多因素逻辑回归分析显示，HAA是预防PPCs的独立保护因素（OR 0.31，95%CI 0.12 - 0.83，P = 0.020）。进一步的探索性分析显示，在肝门阻断期间，高原组血糖水平更稳定（[9.30[7.25 - 11.90]对10.95[7.90 - 14.00]mmol/L，P < 0.001），多次阻断后乳酸蓄积更低（1.55[1.10 - 2.17]对1.70[1.10 - 2.50]mmol/L，P = 0.042）。
HAA可能降低肝切除术后PPCs的发生率和严重程度，这可能是由于高原居民慢性缺氧相关的代谢稳定性增强。
本研究在中国临床试验注册中心注册（注册号：ChiCTR2200061915），于2022年7月11日注册。
