Nasraway S A, Klein R D, Spanier T B, Rohrer R J, Freeman R B, Rand W M, Benotti P N
Department of Anesthesiology, New England Medical Center Hospitals, Boston.
Chest. 1995 Jan;107(1):218-24. doi: 10.1378/chest.107.1.218.
To describe the hemodynamic and oxygen transport patterns in survivors and nonsurvivors following liver transplantation (LT) and to assess their relationship to organ failure and mortality.
Retrospective cohort.
Surgical ICU in a tertiary care university teaching hospital.
Consecutive series of 113 adults undergoing LT between 1984 and 1992. Patients were excluded if they died intraoperatively (n = 2), required retransplantation (n = 8), or their records were incomplete (n = 7).
Preoperative severity of illness was assessed by the acute physiology and chronic health evaluation (APACHE) II scoring system. Hemodynamic and oxygen transport variables were recorded immediately preoperatively and sequentially every 12 h during the first 2 postoperative days. Organ failures (pulmonary, renal, cardiovascular, hepatic, and central nervous system) were assessed for patients in the postoperative period. Patients were grouped as survivors (n = 82) or nonsurvivors (n = 14) with a mortality rate of 15%. Preoperative APACHE II scores were significantly lower in survivors compared with nonsurvivors (7 +/- 0 vs 11 +/- 2; p = 0.029). Both preoperatively and postoperatively, survivors sustained a relatively higher mean arterial pressure, stroke volume index, left ventricular stroke work index, cardiac index, and oxygen delivery as compared with nonsurvivors (p < 0.01). The postoperative decline in systemic blood flow that was seen in both groups was particularly prominent in nonsurvivors during the first 12 h following LT (p < 0.03). Nonsurvivors sustained an approximately fivefold increase in the rate of organ failure (p < 0.0001); all patients (n = 6) with 4 or more organ failures died.
Nonsurvivors of LT have less cardiac reserve pretransplant; postoperatively, they demonstrate early myocardial depression and subsequently lower levels of cardiac index and oxygen delivery. Patients who develop these hemodynamic patterns are more prone to organ failure and death.
描述肝移植（LT）术后存活者和非存活者的血流动力学及氧运输模式，并评估它们与器官衰竭和死亡率的关系。
回顾性队列研究。
一所三级医疗大学教学医院的外科重症监护病房。
1984年至1992年间连续接受LT的113例成年患者。术中死亡（n = 2）、需要再次移植（n = 8）或记录不完整（n = 7）的患者被排除。
采用急性生理与慢性健康状况评估（APACHE）II评分系统评估术前疾病严重程度。术前即刻记录血流动力学和氧运输变量，并在术后第1天的头2天内每12小时依次记录一次。评估术后患者的器官衰竭情况（肺部、肾脏、心血管、肝脏和中枢神经系统）。患者分为存活者（n = 82）和非存活者（n = 14），死亡率为15%。与非存活者相比，存活者术前APACHE II评分显著更低（7±0对11±2；p = 0.029）。与非存活者相比，存活者术前和术后的平均动脉压、每搏量指数、左心室每搏功指数、心指数和氧输送相对更高（p < 0.01）。两组术后全身血流均下降，在LT后的头12小时内，非存活者尤为明显（p < 0.03）。非存活者的器官衰竭发生率增加约五倍（p < 0.0001）；所有发生4种或更多器官衰竭的患者（n = 6）均死亡。
LT的非存活者移植前心脏储备较少；术后，他们表现出早期心肌抑制，随后心指数和氧输送水平较低。出现这些血流动力学模式的患者更容易发生器官衰竭和死亡。
