肝移植术后机械通气时间延长的预测因素及干预措施

王翰; 左祥荣; 曹权

doi:10.3969/j.issn.1001-5256.2020.07.047

肝移植术后机械通气时间延长的预测因素及干预措施

DOI: 10.3969/j.issn.1001-5256.2020.07.047

南京医科大学第一附属医院重症医学科

基金项目:

国家自然科学基金项目(81200159)；江苏省“六大人才高峰”项目(2012-WS-028)；江苏省“青年医学人才”项目(QNRC2016557)；江苏省第五期“333高层次人才培养工程”第三层次人才项目；江苏省高层次卫生人才“六个一工程”拔尖人才科研项目(LGY2019067)；

详细信息

中图分类号: R657.3
计量
- 文章访问数: 829
- HTML全文浏览量: 38
- PDF下载量: 149
- 被引次数: 0
出版历程
- 出版日期: 2020-07-20

Predictive factors and interventions for prolonged mechanical ventilation after liver transplantation

Department of Critical Care Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China

Research funding:

摘要

摘要: 近年来肝移植技术和围手术期管理水平有了很大的提高,但仍有许多围手术期并发症导致受体预后不良。其中术后机械通气时间延长(PMV)是术后早期常见的并发症。PMV导致更易发生术后并发症,住ICU和住院时间延长,病死率增加。近年已有较多研究肝移植术后PMV的文献报道,但尚无总结性统计归纳,也无预防术后PMV的措施。整理归纳了肝移植术后PMV的相关影响因素及可干预手段,以期为临床减少肝移植术后机械通气时间、改善受体预后提供有价值的信息。
- 肝移植 /
- 机械通气时间延长 /
- 预后 /
- 危险因素 /
- 干预措施
Abstract: Despite the great improvements in the techniques and perioperative management of liver transplantation in recent years,there are still several perioperative complications that may lead to the poor prognosis of recipients. Prolonged mechanical ventilation( PMV) is a common complication in the early stage after surgery and may result in a high incidence rate of postoperative complications,prolonged length of stay in the intensive care unit and hospital stay,and an increase in mortality rate. In recent years,many studies have reported PMV after liver transplantation,but no summarization and statistical analysis have been performed and there are still no effective measures to prevent PMV after liver transplantation. This article summarizes the influencing factors and interventions for PMV after liver transplantation,in order to provide valuable information for reducing the duration of mechanical ventilation after liver transplantation and improving the prognosis of liver transplantation recipients.
- liver transplantation /
- prolonged mechanical ventilation /
- prognosis /
- risk factors /
- interventions

HTML全文

参考文献(40)

[1] Liver Failure and Artificial Liver Group,Chinese Society of Infectious Diseases,Chinese Medical Association;Severe Liver Disease and Artificial Liver Group,Chinese Society of Hepatology,Chinese Medical Association.Guideline for diagnosis and treatment of liver failure(2018)[J].J Clin Hepatol,2019,35(1):38-44.(in Chinese)中华医学会感染病学分会肝衰竭与人工肝学组，中华医学会肝病学分会重型肝病与人工肝学组．肝衰竭诊治指南(2018年版)[J]．临床肝胆病杂志，2019,35(1):38-44．

[2] Society of Critical Care Medicine,Chinese Medical Association.Practical guidelines for mechanical ventilation(2006)[J].Chin Crit Care Med,2007,19(2):65-72.(in Chinese)中华医学会重症医学分会．机械通气临床应用指南(2006)[J]．中国危重病急救医学，2007,19(2):65-72．

[3]ROSE L,MCGINLAY M,AMIN R,et al.Variation in definition of prolonged mechanical ventilation[J].Respir Care,2017,62(10):1324-1332．

[4]FERNANDEZ-ZAMORA MD,GORDILLO-BRENES A,BAN-DERAS-BRAVO E,et al.Prolonged mechanical ventilation as a predictor of mortality after cardiac surgery[J].Respir Care,2018,63(5):550-557．

[5]JIN M,MA WG,LIU SY,et al.Predictors of prolonged mechanical ventilation in adults after acute type-A aortic dissection repair[J].J Cardiothor Vasc An,2017,31(5):1580-1587．

[6] SAHINTURK H,OZDEMIRKAN A,ZEYNELOGLU P,et al.Risk factors for postoperative prolonged mechanical ventilation after pediatric liver transplantation[J].Exp Clin Transplant,2019.[Online ahead of print]

[7] DANFORTH D,GABRIEL RA,CLARK AI,et al.Preoperative risk factors for massive transfusion,prolonged ventilation requirements,and mortality in patients undergoing liver transplantation[J].Korean JAnesthesiol,2020,73(1):30-35．

[8]FANG MX,LIU N,HUANG QS,et al.Multifactor analysis of postoperative mechanical ventilation supporting time in patients with orthotopic liver transplantation[J].Clin Focus,2015,30(6):667-670.(in Chinese)方明星，刘娜，黄庆生，等．原位肝移植术后影响机械通气时间的多因素分析[J]．临床荟萃，2015,30(6):667-670．

[9] TSCHUOR C,FERRARESE A,KUEMMERLI C,et al.Allocation of liver grafts worldwide-Is there a best system?[J].J Hepatol,2019,71(4):707-718．

[10]KLEINE M,VONDRAN FW,JOHANNING K,et al.Respiratory risk score for the prediction of 3-month mortality and prolonged ventilation after liver transplantation[J].Liver Transpl,2013,19(8):862-871．

[11]KARAPANAGIOTOU A,KYDONA C,DIMITRIADIS C,et al.Impact of the model for end-stage liver disease(MELD)score on liver transplantation in Greece[J].Transplant Proc,2014,46(9):3212-3215．

[12] SHI J,ZUO XR,CAO Q,et al.Risk factors of postoperatively prolonged mechanical ventilation after liver transplantation[J].Chin JOrgan Transplant,2014,35(11):681-684.(in Chinese)施景，左祥荣，曹权，等．肝移植术后机械通气时间延长的危险因素分析[J]．中华器官移植杂志，2014,35(11):681-684．

[13]YUAN H,TUTTLE-NEWHALL JE,CHAWA V,et al.Prognostic impact of mechanical ventilation after liver transplantation:A national database study[J].Am J Surg,2014,208(4):582-590．

[14]PARK C,KIM D,CHOI J,et al.Intraoperative changes in hyponatremia as a risk factor for prolonged mechanical ventilation after living donor liver transplantation[J].Transplant Proc,2010,42(9):3612-3616．

[15] LEE S,JUNG HS,CHOI JH,et al.Perioperative risk factors for prolonged mechanical ventilation after liver transplantation due to acute liver failure[J].Korean J Anesthesiol,2013,65(3):228-236．

[16] CHENG XS,TAN JC,KIM WR.Management of renal failure in end-stage liver disease:A critical appraisal[J].Liver Transpl,2016,22(12):1710-1719．

[17] Chinese College of Transplant Doctors,Section of Liver Transplantation,Society of Organ Transplantation,Chinese Medical Association.Expert consensus on kidney injury management of liver transplant recipients in China(2017)[J/CD].Chin J Transplant(Electronic Edition),2017,11(3):130-137.(in Chinese)中国医师协会器官移植医师分会，中华医学会器官移植学分会肝移植学组．中国肝移植受者肾损伤管理专家共识(2017版)[J/CD]．中华移植杂志(电子版)，2017,11(3):130-137．

[18]GLANEMANN M,LANGREHR J,KAISERS U,et al.Postoperative tracheal extubation after orthotopic liver transplantation[J].Acta Anaesthesiol Scand,2001,45(3):333-339．

[19]WANG A,AN X,XIA VW.Female gender of the recipient is independently associated with prolonged ventilation time and hospital stay after liver transplantation[J].Transplant Proc,2016,48(1):120-122．

[20]LIU YJ,LI T.An excerpt of International Liver Transplant Society Practice Guidelines:Diagnosis and management of hepatopulmonary syndrome and portopulmonary hypertension(2016)[J].J Clin Hepatol,2016,32(10):1838-1842.(in Chinese)刘以俊，李涛．《2016年国际肝移植学会实践指南:肝肺综合征与门脉性肺动脉高压的诊断与管理》摘译[J]．临床肝胆病杂志，2016,32(10):1838-1842．

[21]FAUCONNET P,KLOPFENSTEIN CE,SCHIFFER E.Hepatopulmonary syndrome:The anaesthetic considerations[J].Eur J Anaesthesiol,2013,30(12):721-730．

[22]MANGUS RS,KINSELLA SB,MARSHALL GR,et al.Mild to moderate pulmonary hypertension in liver transplantation[J].J Surg Res,2013,184(2):1150-1156．

[23]Chinese Society of Hepatology,Chinese Medical Association.Chinese guidelines on the management of liver cirrhosis[J].J Clin Hepatol,2019,35(11):2408-2425.(in Chinese)中华医学会肝病学分会．肝硬化诊治指南[J]．临床肝胆病杂志，2019,35(11):2408-2425．

[24]WEHMEYER MH,HEUER AJ,BENTEN D,et al.High rate of cardiac abnormalities in a postmortem analysis of patients suffering from liver cirrhosis[J].J Clin Gastroenterol,2015,49(10):866-872．

[25]MLLER S,HOVE JD,DIXEN U,et al.New insights into cirrhotic cardiomyopathy[J].Int J Cardiol,2013,167(4):1101-1108．

[26]CARVALHEIRO F,RODRIGUES C,ADREGO T,et al.Diastolic dysfunction in liver cirrhosis:Prognostic predictor in liver transplantation?[J].Transplant Proc,2016,48(1):128-131．

[27]FANG L,JING X,TIAN ZB.A review of the relationship between sarcopenia and cirrhosis[J].Par Ent Nutr,2018,25(5):308-312.(in Chinese)房良，荆雪，田字彬．肌肉减少症与肝硬化的临床研究进展[J]．肠外与肠内营养，2018,25(5):308-312．

[28]BIANCOFIORE G,ROMANELLI AM,BINDI ML,et al.Very early tracheal extubation without predetermined criteria in a liver transplant recipient population[J].Liver Transpl,2001,7(9):777-782．

[29] LEE S,SA GJ,KIM SY,et al.Intraoperative predictors of early tracheal extubation after living-donor liver transplantation[J].Korean JAnesthesiol,2014,67(2):103-109．

[30] GAO SN,MA N,LIU L,et al.Risk factors for early acute renal failure after liver transplantation[J/CD].Prac J Organ Transplant(Electronic Version),2013,1(4):216-220.(in Chinese)高思楠，马宁，刘蕾，等．肝移植术后早期急性肾功能衰竭的危险因素分析[J/CD]．实用器官移植电子杂志，2013,1(4):216-220．

[31]KARAPANAGIOTOU A,KYDONA C,PAPADOPOULOS S,et al.The effect of hyponatremia on the outcome of patients after orthotopic liver transplantation[J].Transplant Proc,2012,44(9):2724-2726．

[32] LUI JK,SPAHO L,HOLZWANGER E,et al.Intensive care of pulmonary complications following liver transplantation[J].J Intensive Care Med,2018,33(11):595-608．

[33] CHAN KC,WU CY,HUNG MH,et al.Patterns of perioperative thoracic fluid indices changes in liver transplantation with or without postoperative acute lung injury[J].J Formos Med Assoc,2017,116(6):432-440．

[34]GARUTTI I,SANZ J,OLMEDILLA L,et al.Extravascular lung water and pulmonary vascular permeability index measured at the end of surgery are independent predictors of prolonged mechanical ventilation in patients undergoing liver transplantation[J].Anesth Analg,2015,121(3):736-745．

[35]FANG MX,LIU N,HUANG QS,et al.Influence of central venous pressure on mechanical ventilation time as goal of controlling fluid after liver transplantation[J].Chin J Mod Med,2015,25(2):95-98.(in Chinese)方明星，刘娜，黄庆生，等．以中心静脉压为目标的容量控制对肝移植术后机械通气时间的影响[J]．中国现代医学杂志，2015,25(2):95-98．

[36]IKEGAMI T,SHIRABE K,MATONO R,et al.Etiologies,risk factors,and outcomes of bacterial pneumonia after living donor liver transplantation[J].Liver Transplant,2012,18(9):1060-1068．

[37]MAZZA E,PROSPERI M,PANZERI MF,et al.Carbapenem-resistant klebsiella pneumoniae infections early after liver transplantation:A single-center experience[J].Transplant Proc,2017,49(4):677-681．

[38] GIANNELLA M,BARTOLETTI M,CAMPOLI C,et al.The impact of carbapenemase-producing Enterobacteriaceae colonization on infection risk after liver transplantation:A prospective observational cohort study[J].Clin Microbiol Infect,2019,25(12):1525-1531．

[39]WANG WL,LI QS,ZHOU Y,et al.Analysis of risk factors of early acute kidney injury after liver transplantation from DCD donor liver[J].Ogran Transplantation,2018,9(2):130-136.(in Chinese)王万里，李青山，周颖，等．DCD供肝肝移植术后早期急性肾损伤相关危险因素分析[J]．器官移植，2018,9(2):130-136．

[40] DELLAVOLPE J,AL-KHAFAJI A.Acute kidney injury before and after liver transplant[J].J Intensive Care Med,2019,34(9):687-695.

施引文献

资源附件(0)

访问统计