切换至 "中华医学电子期刊资源库"
高级检索
中华普通外科学文献(电子版)

中华普通外科学文献(电子版) ›› 2023, Vol. 17 ›› Issue (05) : 366 -371. doi: 10.3877/cma.j.issn.1674-0793.2023.05.009

论著

肝移植术后二次气管插管的危险因素及预测模型的建立
李坤河, 寇萌佳, 邝立挺†()   
  1. 510080　广州，中山大学附属第一医院麻醉科
  • 收稿日期:2023-02-01 出版日期:2023-10-01
  • 通信作者: 邝立挺

Risk factors and prediction model of reintubation after liver transplantation

Kunhe Li, Mengjia Kou, Liting Kuang†()   

  1. Department of Anesthesiology, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China
  • Received:2023-02-01 Published:2023-10-01
  • Corresponding author: Liting Kuang
全文 ( ) 下载PDF ( ) 导出引用
引用本文：

李坤河, 寇萌佳, 邝立挺. 肝移植术后二次气管插管的危险因素及预测模型的建立[J]. 中华普通外科学文献(电子版), 2023, 17(05): 366-371.

Kunhe Li, Mengjia Kou, Liting Kuang. Risk factors and prediction model of reintubation after liver transplantation[J]. Chinese Archives of General Surgery(Electronic Edition), 2023, 17(05): 366-371.

目的

探讨肝移植术后二次气管插管的危险因素，建立并验证预测模型。

方法

回顾性分析2016年1月至2021年12月在中山大学附属第一医院接受肝移植术的500例患者的临床资料，分为二次气管插管组（R组，21例）和对照组（C组，479例）。比较两组患者围手术期临床资料，分析肝移植术后二次气管插管的危险因素及预后情况。建立列线图预测模型，并运用受试者工作特征（ROC）曲线和拟合优度检验进行评价。

结果

500例接受肝移植术的患者术后二次气管插管发生率为4.2%（21/500）。多因素Logistic回归分析结果显示，术前终末期肝病模型（MELD）评分高、术后48 h血肌酐（Scr）升高、术后丙氨酸氨基转移酶（ALT）峰值是术后二次气管插管的独立危险因素。将上述危险因素绘制ROC曲线，曲线下面积为0.790（95% CI：0.677~0.903，P<0.001）。制作肝移植术后二次气管插管的列线图预测模型，根据得分实现对肝移植术后二次气管插管的初步预测。

结论

接受肝移植术的患者，术前MELD评分高、术后48 h Scr升高、术后ALT峰值是术后二次气管插管的独立危险因素。

关键词: 肝移植, 二次气管插管, 术后, 危险因素, 回顾性, 预测模型
Objective

To explore the risk factors of reintubation after liver transplantation, establish and validate prediction model, so as to provide reference for clinical practice.

Methods

A retrospective study was conducted in 500 patients who underwent liver transplantation in the First Affiliated Hospital of Sun Yat-sen University from January 2016 to December 2021. The selected patients were divided into reintubation group (Group R, 21 cases) and control group (Group C, 479 cases). The perioperative clinical data of the two groups were compared, and the risk factors and prognosis of reintubation after liver transplantation were analyzed.

Results

The incidence of reintubation in patients undergoing liver transplantation was 4.2% (21/500). Multivariate logistic regression analysis showed that high MELD score, elevated serum creatinine (Scr) 48 hours after operation, and alanine aminotransferase (ALT) peak value after operation were independent risk factors for reintubation after operation. The ROC curve was drawn for the above risk factors, and the area under the curve was 0.790 (95% CI: 0.677-0.903, P<0.001). The Nomogram prediction model of reintubation after liver transplantation was made, and the preliminary prediction of reintubation after liver transplantation was realized according to the score.

Conclusion

For patients undergoing liver transplantation, high MELD score before operation, increased Scr at 48 hours after operation, and peak ALT after operation are independent risk factors for reintubation after operation.

Key words: Liver transplantation, Reintubation, Postoperative, Risk factors, Retrospective, Predictive model
表1 二次气管插管组与对照组肝移植患者术前一般资料的比较
项目 C组 R组 统计值 P值
例数 479 21    
年龄(岁) 52.12±10.87 50.76±10.91 0.558 0.577
性别a     1.759 0.259
男 431(90.0) 17(81.0)    
女 48(10.0) 4(19.0)    
体质指数(kg/m2) 23.27±3.56 21.82±3.31 1.837 0.067
ASA分级a     2.337 0.498
Ⅱ 43(9.0) 3(14.3)    
Ⅲ 301(62.8) 10(47.6)    
Ⅳ 135(28.2) 8(138.1)    
MELD评分(分) 24.01±7.46 30.11±11.15 -3.582 0.022
MELD-Na评分(分) 24.31±7.56 29.95±11.29 -3.267 0.034
术前合并症a        
高血压病 69(14.4) 2(9.5) 0.393 0.753
糖尿病 69(14.4) 1(4.8) 1.554 0.336
肝硬化 345(72.0) 15(71.4) 0.004 0.952
肝衰竭 73(15.2) 9(42.9) 11.192 0.003
术前实验室检查        
Hb(g/L) 114.97±29.03 105.05±32.02 1.526 0.128
PLT(×109/L)b 85.5(49,144) 83(56,182) 0.696 0.486
ALB(g/L) 36.89±5.46 36.67±6.08 0.180 0.857
TBIL(μmol/L)b 29.2(17.1,102.4) 343.3(99.1,483.8) 2.310 0.021
ALT(U/L)b 29.0(19.0，46.0) 52.0(45.0,104.0) 1.734 0.083
AST(U/L)b 43.0(32.0,70.0) 142.0(65.0,222.0) 3.079 0.002
GGT(U/L)b 66.5（36.0,122.5) 85.0(46.0,250.0) 0.864 0.387
LDH(U/L)b 215.0(183.0,259.0) 270.0(209.0,286.0) 1.497 0.134
表2 二次气管插管组与对照组肝移植患者术中情况的比较
项目 C组 R组 统计值 P值
例数 479 21    
手术时间(min)a 451(394,520) 427(377,485) 0.590 0.555
阻断肝门时间(min)a 54.0(44.5,65.0) 52.0(43.0,57.0) 0.360 0.719
阻断下腔时间(min)a 49.0(40.0,57.0) 47.0(41.0,58.0) 0.057 0.954
术中出血量(ml)a 1 500(800,2 500) 2 000(1 200,3 600) 2.107 0.035
输红细胞量(ml)a 920(400,1 600) 1 550(600,3 600) 2.269 0.023
输血浆量(ml)a 1 400(1 000,2 000) 1 600(1 000,2 800) 1.930 0.054
输冷沉淀(U) 5.71±7.84 6.29±8.11 -0.330 0.741
输血小板(U) 0.81±2.49 0.33±0.48 0.866 0.387
表3 二次气管插管组与对照组肝移植患者术后情况的比较[M（P25，P75）]
项目 C组 R组 Z值 P值
例数 479 21    
术后48 h Scr (μmol/L) 79.0(64.0,99.5) 99.0(74.0,167.0) -2.631 0.009
术后24 h PT (s) 17.2(15.4,20.1) 19.9(17.4,21.7) -2.599 0.009
术后24 h INR 1.47(1.31,1.74) 1.78(1.55,1.91) -2.688 0.007
术后24 h APTT (s) 50.1(41.0,61.8) 62.1(55.0,73.0) -3.814 <0.001
术后24 h FIB(g/L) 1.69(1.35,2.07) 1.35(1.25,1.63) -3.014 0.003
术后24 h血氨(μmol/L) 32.0(21.0，47.0) 49.0(33.0,60.0) -2.507 0.012
术后ALT峰值(U/L) 623(327,976) 782(452,1183) -2.227 0.026
术后AST峰值(U/L) 1243(737,2223) 1850(1356,2778) -3.141 0.002
表4 肝移植患者术后二次气管插管危险因素的多因素Logistic回归分析
危险因素 B SE Wald df P值 OR 95% CI
术前MELD评分 0.082 0.027 9.481 1 0.002 1.086 1.030~1.144
术后48 h Scr 0.008 0.003 8.100 1 0.004 1.008 1.003~1.014
术后24 h APTT 0.008 0.009 0.873 1 0.350 1.009 0.991~1.027
术后ALT峰值 <0.001 <0.001 5.299 1 0.021 1.001 1.000~1.001
图1 肝移植术后二次气管插管的列线图预测模型
图2 肝移植术后二次气管插管发生概率　A为ROC曲线；B为H-L校正曲线
[1]
Sapisochin G, Bruix J. Liver transplantation for hepatocellular carcinoma: outcomes and novel surgical approaches[J]. Nat Rev Gastroenterol Hepatol, 2017, 14(4): 203-217.
[2]
Baganate F, Beal EW, Tumin D, et al. Early mortality after liver transplantation: defining the course and the cause[J]. Surgery, 2018, 164(4): 694-704.
[3]
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.
[4]
Comellini V, Pacilli AMG, Nava S. Benefits of non-invasive ventilation in acute hypercapnic respiratory failure[J]. Respirology, 2019, 24(4): 308-317.
[5]
Brovman EY, Tolis G, Hirji S, et al. Association between early extubation and postoperative reintubation after elective cardiac surgery: A bi-institutional study[J]. J Cardiothorac Vasc Anesth, 2022, 36(5): 1258-1264.
[6]
Chen S, Zhang Y, Che L, et al. Risk factors for unplanned reintubation caused by acute airway compromise after general anesthesia: A case-control study [J]. BMC Anesthesiol, 2021, 21(1): 17.
[7]
Brovman EY, Steen TL, Urman RD. Associated risk factors and complications in vascular surgery patients requiring unplanned postoperative reintubation[J]. J Cardiothorac Vasc Anesth, 2017, 31(2): 554-561.
[8]
Wilson LA, Zubizarreta N, Bekeris J, et al. Risk factors for reintubation after anterior cervical discectomy and fusion surgery: evaluation of three observational data sets[J]. Can J Anaesth, 2020, 67(1): 42-56.
[9]
Glanemann M, Kaisers U, Langrehr JM, et al. Incidence and indications for reintubation during postoperative care following orthotopic liver transplantation[J]. J Clin Anesth, 2001, 13(5): 377-382.
[10]
Malinchoc M, Kamath PS, Gordon FD, et al. A model to predict poor survival in patients undergoing transjugular intrahepatic portosystemic shunts[J]. Hepatology, 2000, 31(4): 864-871.
[11]
余忠山, 江艺, 蔡秋程, 等. MELD评分和CTP分级评估肝移植术后并发症及死亡风险的临床分析[J/CD]. 中华普通外科学文献(电子版), 2013, 7(6): 466-471.
[12]
陈永泰, 许蜂蜂, 王明, 等. 终末期肝病模型评分及MELD-Na评分评估肝衰竭肝移植短期预后的对比观察[J/CD]. 中华普通外科学文献(电子版), 2020, 14(3): 195-199.
[13]
Dashti H, Ebrahimi A, Khorasani NR, et al. The utility of early post-liver transplantation model for end-stage liver disease score in prediction of long-term mortality[J]. Ann Gastroenterol, 2019, 32(6): 633-641.
[14]
Lai Y, Crowley J, Dalia AA. Model for end-stage liver disease impact on outcomes of orthotopic liver transplantation patients[J]. J Cardiothorac Vasc Anesth, 2019, 33(10): 2726-2727.
[15]
Pommergaard HC, Daugaard TR, Rostved AA, et al. Model for end-stage liver disease score predicts complications after liver transplantation[J]. Langenbecks Arch Surg, 2021, 406(1): 55-65.
[16]
Guo M, Gao Y, Wang L, et al. Early acute kidney injury associated with liver transplantation: A retrospective case-control study[J]. Med Sci Monit, 2020, 26: e923864.
[17]
Khwaja A. KDIGO clinical practice guidelines for acute kidney injury[J]. Nephron Clin Pract, 2012, 120(4): c179-c184.
[18]
Kim WH, Lee HC, Lim L, et al. Intraoperative oliguria with decreased SvO2 predicts acute kidney injury after living donor liver transplantation[J]. J Clin Med, 2018, 8(1): 29.
[19]
Zhao C, Li Y, Pan G, et al. Risk factors for postoperative acute kidney injury in patients undergoing redo cardiac surgery using cardiopulmonary bypass[J]. J Cardiovasc Dev Dis, 2022, 9(8): 244.
[20]
Deng Y, Yuan J, Chi R, et al. The incidence, risk factors and outcomes of postoperative acute kidney injury in neurosurgical critically ill patients[J]. Sci Rep, 2017, 7(1): 4245.
[21]
Ishikawa S, Griesdale DE, Lohser J. Acute kidney injury after lung resection surgery: incidence and perioperative risk factors[J]. Anesth Analg, 2012, 114(6): 1256-1262.
[22]
Mueller AK, Senninger N, Vowinkel T. Relevance of postoperative peak transaminase after elective hepatectomy[J]. Ann Surg, 2014, 260(5): 815-821.
[23]
Chen S, Wang H, Luo D, et al. Postoperative alanine aminotransferase levels are associated with outcomes in pediatric patients undergoing total cavopulmonary connection[J]. Children (Basel), 2022, 9(9): 1410.
[24]
Holndonner-Kirst E, Nagy A, Czobor NR, et al. Higher transaminase levels in the postoperative period after orthotopic heart transplantation are associated with worse survival[J]. J Cardiothorac Vasc Anesth, 2018, 32(4): 1711-1718.
[1] 刘欢颜, 华扬, 贾凌云, 赵新宇, 刘蓓蓓. 颈内动脉闭塞病变管腔结构和血流动力学特征分析[J]. 中华医学超声杂志（电子版）, 2023, 20(08): 809-815.
[2] 马艳波, 华扬, 刘桂梅, 孟秀峰, 崔立平. 中青年人颈动脉粥样硬化病变的相关危险因素分析[J]. 中华医学超声杂志（电子版）, 2023, 20(08): 822-826.
[3] 陈旭渊, 罗仕云, 李文忠, 李毅. 腺源性肛瘘经手术治疗后创面愈合困难的危险因素分析[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 82-85.
[4] 唐旭, 韩冰, 刘威, 陈茹星. 结直肠癌根治术后隐匿性肝转移危险因素分析及预测模型构建[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 16-20.
[5] 李建美, 邓静娟, 杨倩. 两种术式联合治疗肝癌合并肝硬化门静脉高压的安全性及随访评价[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 41-44.
[6] 吴方园, 孙霞, 林昌锋, 张震生. HBV相关肝硬化合并急性上消化道出血的危险因素分析[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 45-47.
[7] 逄世江, 黄艳艳, 朱冠烈. 改良π形吻合在腹腔镜全胃切除消化道重建中的安全性和有效性研究[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 66-69.
[8] 杨体飞, 杨传虎, 陆振如. 改良无充气经腋窝入路全腔镜下甲状腺手术对喉返神经功能的影响研究[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 74-77.
[9] 郭震天, 张宗明, 赵月, 刘立民, 张翀, 刘卓, 齐晖, 田坤. 机器学习算法预测老年急性胆囊炎术后住院时间探索[J]. 中华临床医师杂志(电子版), 2023, 17(9): 955-961.
[10] 陆猛桂, 黄斌, 李秋林, 何媛梅. 蜂蛰伤患者发生多器官功能障碍综合征的危险因素分析[J]. 中华临床医师杂志(电子版), 2023, 17(9): 1010-1015.
[11] 李达, 张大涯, 陈润祥, 张晓冬, 黄士美, 陈晨, 曾凡, 陈世锔, 白飞虎. 海南省东方市幽门螺杆菌感染现状的调查与相关危险因素分析[J]. 中华临床医师杂志(电子版), 2023, 17(08): 858-864.
[12] 李琪, 黄钟莹, 袁平, 关振鹏. 基于某三级医院的ICU多重耐药菌医院感染影响因素的分析[J]. 中华临床医师杂志(电子版), 2023, 17(07): 777-782.
[13] 王亚丹, 吴静, 黄博洋, 王苗苗, 郭春梅, 宿慧, 王沧海, 王静, 丁鹏鹏, 刘红. 白光内镜下结直肠肿瘤性质预测模型的构建与验证[J]. 中华临床医师杂志(电子版), 2023, 17(06): 655-661.
[14] 孟科, 李燕, 闫婧爽, 闫斌. 胶囊内镜胃通过时间的影响因素分析[J]. 中华临床医师杂志(电子版), 2023, 17(06): 671-675.
[15] 杨艳丽, 陈昱, 赵若辰, 杜伟, 马海娟, 许珂, 张莉芸. 系统性红斑狼疮合并血流感染的危险因素及细菌学分析[J]. 中华临床医师杂志(电子版), 2023, 17(06): 694-699.
阅读次数
全文


摘要

版权所有 中华医学会 中华医学电子音像出版社有限责任公司  京ICP备14006079号-1  网络出版服务许可证：(署)网出证(京)字第075号