目的 探讨肝移植术后机械通气时间延长的危险因素及其对患者预后的影响.方法 采用病例对照研究方法,回顾性收集2018 年1 月—2021 年12 月在浙江大学医学院附属第一医院进行肝移植术的654 例住院患者的相关资料,分析其术后机械通气时间延长的独立危险因素.结果 纳入本研究的654 例肝移植术后患者中,有 169 例患者发生机械通气时间延长,发生率为 25.84%.Logistic回归分析结果显示,终末期肝病模型(model for end-stage liver disease,MELD)评分高(OR:1.083,95%CI:1.058～1.110),美国麻醉医师协会(American Society of Anesthesiologists,ASA)分级>3 级(OR:1.657,95%CI:1.065～2.576),术中出血量>1 250 mL(OR:5.559,95%CI:3.647～8.471),术中尿量≤800 mL(OR:2.026,95%CI:1.331～3.082)是肝移植术后发生机械通气时间延长的独立危险因素.结论 临床医护人员需要重点关注MELD评分较高、ASA分级>3 级、术中出血量>1 250 mL、术中尿量≤800 mL的患者,早期采取针对性的干预措施,以缩短肝移植患者术后机械通气时间,促进患者早期康复.
Risk factors and prognosis of prolonged mechanical ventilation among patients after liver transplantation
Objective To explore risk factors of prolonged mechanical ventilation(PMV)and its impact on the prognosis among patients after liver transplantation.Methods In this retrospective case-control study,relevant information of 654 patients after liver transplantation in The First Affiliated Hospital,Zhejiang University School of Medicine from January 2018 to December 2021 was collected,and then it was performed to analyze the independent risk factors of PMV among patients after liver transplantation.Results A total of 654 patients after liver transplantation were recruited,169 patients developed prolonged mechanical ventilation,and the overall incidence of PMV was25.84%.Logistic regression analysis indicated that high model for end-stage liver disease(MELD)score(OR:1.083,95%CI:1.058-1.110),American Society of Anesthesiologists(ASA)rating>3(OR:1.657,95%CI:1.065-2.576),intraoperative blood loss>1 250 mL(OR:5.559,95%CI:3.647-8.471),intraoperative urine output≤800 mL(OR:2.026,95%CI:1.331-3.082)were the independent risk factors of PMV among patients after liver transplantation.Conclusions Medical staff should pay attention to patients with high MELD score,ASA rating>3,intraoperative blood loss>1 250 mL,and intraoperative urine output≤800 mL,and take targeted intervention measures early to shorten the time of postoperative mechanical ventilation and promote rapid recovery.
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