Analysis of factors affecting prolonged mechanical ventilation after liver transplantation

doi:10.3877/cma.j.issn.1674-0793.2022.01.007

Abstract

Abstract:

Objective

To investigate the clinical features, prognosis of patients with prolonged mechanical ventilation (PMV) after liver transplantation and the related factors affecting the occurrence of PMV.

Methods

The data of 105 adult patients with liver transplantation from April 2016 to April 2021 treated in the First Affiliated Hospital of Anhui Medical University were retrospectively analyzed. They were divided into PMV group (39 cases) and non-PMV group (66 cases) based on whether the postoperative mechanical ventilation time exceeded 24 hours. The general data, clinical characteristics and prognosis of the two groups were compared. Univariate analysis and logistic regression model were used to screen the factors affecting PMV after liver transplantation. Survival analysis was performed using Kaplan-Meier curves.

Results

Previous history of upper abdominal surgery (OR=0.284, 95% CI: 0.084-0.963, P=0.043) and preoperative Child-Pugh score (OR=1.439, 95% CI: 1.026-2.017, P=0.035) were independent risk factors for PMV after liver transplantation. The 180-day survival rate was 74.36% in PMV group and 84.85% in non-PMV group, with no significant difference (Log-rank χ²=0.061, P=0.804).

Conclusions

Preoperative upper abdominal surgery and preoperative Child-Pugh score are independent influencing factors of PMV after liver transplantation. PMV results in higher resistance bacterial infections rate without affecting the 6-month survival rate of patients after liver transplantation. Fully handling the preoperative complications and reducing the factors leading to PMV can shorten the time of mechanical ventilation as much as possible, which is beneficial to the patients.

Key words: Liver transplantation, Mechanical ventilation time, Prolonged, Factors, Prognosis

Liangwen Cui, Enqiang Guo, Liujin Hou, Fan Huang, Xiaochun Peng, Hongchuan Zhao, Min Shao, Nian Liu. Analysis of factors affecting prolonged mechanical ventilation after liver transplantation[J]. Chinese Archives of General Surgery(Electronic Edition), 2022, 16(01): 37-41.

/ / Recommend

Add to citation manager EndNote|Ris|BibTeX

URL: https://zhptwkxwx.cma-cmc.com.cn/EN/10.3877/cma.j.issn.1674-0793.2022.01.007

https://zhptwkxwx.cma-cmc.com.cn/EN/Y2022/V16/I01/37

Figures/Tables 3

References 14

[1]	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]	Rose L, McGinlay M, Amin R, et al. Variation in definition of prolonged mechanical ventilation[J]. Respir Care, 2017, 62(10): 1324-1332.
[3]	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 J Anesthesiol, 2020, 73(1): 30-35.
[4]	Levesque E, Hoti E, Azoulay D, et al. Pulmonary complications after elective liver transplantation-incidence, risk factors, and outcome[J]. Transplantation, 2012, 94(5): 532-538.
[5]	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.
[6]	孟稳利，刘志华，缪洁. 肝移植术后肺部感染相关因素临床分析[J]. 中国现代医学杂志, 2013, 23(22): 104-106.
[7]	Serpa Neto A, Hemmes SN, Barbas CS, et al. Protective versus conventional ventilation for surgery: A systematic review and individual patient data Meta-analysis[J]. Anesthesiology, 2015, 123(1): 66-78.
[8]	陆之辉，刘立新，李秀华, 等. 定时使用阿托品对腹部手术老年人全麻苏醒期低氧血症的预防作用[J]. 中国老年学杂志, 2015, 35(10): 2831-2832.
[9]	Ahmed AA. Dysfunction of the diaphragm[J]. N Engl J Med, 2012, 366(21): 2036-2037.
[10]	赵首捷，杨振宇，雷世雄, 等. Child-Pugh评分和ALBI分级对BCLC-B期肝癌生存预后预测价值比较[J/CD]. 中华肝脏外科手术学电子杂志, 2021, 10(1): 38-42.
[11]	Zhao S, Wang M, Yang Z, et al. Comparison between Child-Pugh score and albumin-bilirubin grade in the prognosis of patients with HCC after liver resection using time-dependent ROC[J]. Ann Transl Med, 2020, 8(8): 539.
[12]	张长坤，张龙辉，王东, 等. 术前肝功能Child-Pugh评分与白蛋白-胆红素评分对肝癌患者肝切除术后肝衰竭和预后的预测价值[J]. 中华消化外科杂志, 2018, 17(5): 474-482.
[13]	胡骁，孙琳，付晓悦, 等. 围手术期营养支持对肝移植患者蛋白质代谢及免疫功能的影响[J]. 中国普外基础与临床杂志, 2017, 24(3): 338-341.
[14]	王翰，左祥荣，曹权. 肝移植术后机械通气时间延长的预测因素及干预措施[J]. 临床肝病杂志, 2020, 36(7): 1658-1662.

项目		非PMV组	PMV组	统计值	P值
例数		66	39
年龄(岁)		45.98±10.82	45.28±11.46	t=0.32	0.75
性别[男,例(%)]		53(80.30)	26 (66.67)	χ²=2.45	0.12
体质指数(kg/m²)		23.34±3.11	22.35±3.47	t=1.51	0.14
肝脏基础疾病[例(%)]
	乙肝肝硬化失代偿	44 (66.67)	25 (64.10)	χ²=0.72	0.79
	肝癌	18 (27.27)	7 (17.95)	χ²=1.18	0.28
	ACLF	13 (19.70)	17 (43.59)	χ²=6.86	0.01
术前Child-Pugh评分		9.00 (7.00, 11.00)	10.00 (9.00, 12.00)	Z=-3.85	<0.01
术前MELD评分		15.00 (11.00, 22.00)	23.00 (15.00, 30.00)	Z=-3.15	<0.01
肝移植原因[例(%)]^a
	乙肝肝硬化	40(60.61)	19 (48.72)	χ²=2.11	0.35
	混合型肝硬化	4 (6.06)	5 (12.82)	χ²=2.06	0.36
	其他	22 (33.33)	15 (38.46)	χ²=0.81	0.37
上腹部手术史[例(%)]		8 (12.12)	12 (30.77)	χ²=5.53	0.02
门静脉血栓[例(%)]		6 (9.09)	2 (5.13)	χ²=0.55	0.46
既往行TIPS术[例(%)]		8 (12.12)	3 (7.69)	χ²=0.51	0.48
术前住院时间(d)^b		1.00 (0, 4.00)	3.00 (0, 26.00)	Z=-1.64	0.10
手术方式[例(%)]
	经典原位肝移植	56 (84.85)	33 (84.62)	χ²=0.00	1.00
	背驮式肝移植	10 (15.15)	6 (15.38)	χ²=0.00	1.00
手术时间(h)		6.83 (6.13, 7.87)	7.83 (6.83, 8.67)	Z=-3.19	<0.01
无肝期时间(min)		53.50 (50.00, 63.00)	60.00 (50.00, 68.00)	Z=-1.50	0.13
术中出血量(ml)		800.00 (400.00, 1 000.00)	1000.00 (800.00, 1 500.00)	Z=-2.80	0.01
输红细胞量(U)		4.00 (2.75, 8.25)	7.00 (4.00, 12.00)	Z=-2.35	0.02
输血浆量(ml)		1 000.00 (800.00, 1 712.50)	1 600.00 (800.00, 2 250.00)	Z=-1.94	0.05
病肝重量(g)		1 025.50 (843.75, 1 189.00)	900.00 (790.00, 1 190.00)	Z=-1.40	0.16
供肝质量(g)		1 394.78±239.82	1 356.79±333.32	t=0.68	0.50
GRWR		2.12±0.43	2.19±0.52	t=-0.67	0.50
继发耐药菌感染[例(%)]		12 (18.18)	14 (35.90)	χ²=12.40	<0.01
CRRT[例(%)]		3 (4.55)	6 (15.38)	χ²=3.68	0.06
再次手术[例(%)]		3 (4.55)	4 (10.26)	χ²=1.29	0.26
180 d生存时间(d)		180.00 (180.00, 180.00)	180.00 (180.00, 180.00)	Z=-1.49	0.14

项目		非PMV组	PMV组	统计值	P值
例数		66	39
年龄(岁)		45.98±10.82	45.28±11.46	t=0.32	0.75
性别[男,例(%)]		53(80.30)	26 (66.67)	χ²=2.45	0.12
体质指数(kg/m²)		23.34±3.11	22.35±3.47	t=1.51	0.14
肝脏基础疾病[例(%)]
	乙肝肝硬化失代偿	44 (66.67)	25 (64.10)	χ²=0.72	0.79
	肝癌	18 (27.27)	7 (17.95)	χ²=1.18	0.28
	ACLF	13 (19.70)	17 (43.59)	χ²=6.86	0.01
术前Child-Pugh评分		9.00 (7.00, 11.00)	10.00 (9.00, 12.00)	Z=-3.85	<0.01
术前MELD评分		15.00 (11.00, 22.00)	23.00 (15.00, 30.00)	Z=-3.15	<0.01
肝移植原因[例(%)]^a
	乙肝肝硬化	40(60.61)	19 (48.72)	χ²=2.11	0.35
	混合型肝硬化	4 (6.06)	5 (12.82)	χ²=2.06	0.36
	其他	22 (33.33)	15 (38.46)	χ²=0.81	0.37
上腹部手术史[例(%)]		8 (12.12)	12 (30.77)	χ²=5.53	0.02
门静脉血栓[例(%)]		6 (9.09)	2 (5.13)	χ²=0.55	0.46
既往行TIPS术[例(%)]		8 (12.12)	3 (7.69)	χ²=0.51	0.48
术前住院时间(d)^b		1.00 (0, 4.00)	3.00 (0, 26.00)	Z=-1.64	0.10
手术方式[例(%)]
	经典原位肝移植	56 (84.85)	33 (84.62)	χ²=0.00	1.00
	背驮式肝移植	10 (15.15)	6 (15.38)	χ²=0.00	1.00
手术时间(h)		6.83 (6.13, 7.87)	7.83 (6.83, 8.67)	Z=-3.19	<0.01
无肝期时间(min)		53.50 (50.00, 63.00)	60.00 (50.00, 68.00)	Z=-1.50	0.13
术中出血量(ml)		800.00 (400.00, 1 000.00)	1000.00 (800.00, 1 500.00)	Z=-2.80	0.01
输红细胞量(U)		4.00 (2.75, 8.25)	7.00 (4.00, 12.00)	Z=-2.35	0.02
输血浆量(ml)		1 000.00 (800.00, 1 712.50)	1 600.00 (800.00, 2 250.00)	Z=-1.94	0.05
病肝重量(g)		1 025.50 (843.75, 1 189.00)	900.00 (790.00, 1 190.00)	Z=-1.40	0.16
供肝质量(g)		1 394.78±239.82	1 356.79±333.32	t=0.68	0.50
GRWR		2.12±0.43	2.19±0.52	t=-0.67	0.50
继发耐药菌感染[例(%)]		12 (18.18)	14 (35.90)	χ²=12.40	<0.01
CRRT[例(%)]		3 (4.55)	6 (15.38)	χ²=3.68	0.06
再次手术[例(%)]		3 (4.55)	4 (10.26)	χ²=1.29	0.26
180 d生存时间(d)		180.00 (180.00, 180.00)	180.00 (180.00, 180.00)	Z=-1.49	0.14

变量	β	SE	Wals值	P值	OR值	95% CI
上腹部手术史（1）	-1.259	0.623	4.083	0.043	0.284	0.084~0.963
ACLF（1）	1.049	0.662	2.514	0.113	0.350	0.096~1.281
术前Child-Pugh评分	0.364	0.172	4.457	0.035	1.439	1.026~2.017
术前MELD评分	0.012	0.041	0.087	0.768	1.012	0.934~1.097
手术时间	0.345	0.186	3.440	0.064	1.412	0.981~2.032
术中出血量	0.001	0.001	0.945	0.331	1.001	0.999~1.002
输红细胞量	0.021	0.079	0.070	0.792	1.021	0.875~1.192
输血浆量	0.000	0.000	0.697	0.404	1.000	0.999~1.001
常量	-3.236	2.793	1.342	0.247	0.039

变量	β	SE	Wals值	P值	OR值	95% CI
上腹部手术史（1）	-1.259	0.623	4.083	0.043	0.284	0.084~0.963
ACLF（1）	1.049	0.662	2.514	0.113	0.350	0.096~1.281
术前Child-Pugh评分	0.364	0.172	4.457	0.035	1.439	1.026~2.017
术前MELD评分	0.012	0.041	0.087	0.768	1.012	0.934~1.097
手术时间	0.345	0.186	3.440	0.064	1.412	0.981~2.032
术中出血量	0.001	0.001	0.945	0.331	1.001	0.999~1.002
输红细胞量	0.021	0.079	0.070	0.792	1.021	0.875~1.192
输血浆量	0.000	0.000	0.697	0.404	1.000	0.999~1.001
常量	-3.236	2.793	1.342	0.247	0.039

[1]	Jiajia Liu, Chenghua Wang, Xujiao Chen, Yuanling Liu, Shanyu Wang, Haihua Qu, Li Zhang. Risk factors for pain in patients undergoing transvaginal real-time three-dimensional hysterosalpingo-contrast sonography [J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2023, 20(09): 959-965.
[2]	Huanyan Liu, Yang Hua, Lingyun Jia, Xinyu Zhao, Beibei Liu. Lumen structure and hemodynamic characteristics of occluded internal carotid artery [J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2023, 20(08): 809-815.
[3]	Yanbo Ma, Yang Hua, Guimei Liu, Xiufeng Meng, Liping Cui. Risk factors for carotid atherosclerotic lesions in middle adults [J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2023, 20(08): 822-826.
[4]	Xiaoli Yi, Shasha Hu, Yan Zhang. Impact of HER-2 low expression on response of neoadjuvant chemotherapy and prognosis in breast cancer patients [J]. Chinese Journal of Breast Disease(Electronic Edition), 2023, 17(06): 340-346.
[5]	Xu Tang, Bing Han, Wei Liu, Ruxing Chen. Analysis of risk factors for metachronous liver metastases after radical colorectal cancer surgery and construction of a predictive model [J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2024, 18(01): 16-20.
[6]	Qian Yang, Cuifang Li, Wanqiu Zhang. Analysis of short-term and long-term prognosis and influencing factors of primary liver cancer with spontaneous ruptured hemorrhage after emergency TACE surgery [J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2024, 18(01): 33-36.
[7]	Fangyuan Wu, Xia Sun, Changfeng Lin, Zhensheng Zhang. Risk factors of HBV-associated cirrhosis complicated with acute upper gastrointestinal bleeding [J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2024, 18(01): 45-47.
[8]	Yansong Li, Huimin Feng, Mingchao Liu, Zepeng Liu, Qiuxia Jiang. Expression and clinical significance of STIP1 in triple negative breast cancer [J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2024, 18(01): 52-56.
[9]	Yongsheng Li, Jiahe Sun, Shuwei Guo, Yikang Lu, Hongzhou Liu. Short-term postoperative complications and their influencing factors in elderly patients with colorectal cancer [J]. Chinese Journal of Clinicians(Electronic Edition), 2023, 17(9): 962-967.
[10]	Menggui Lu, Bin Huang, Qiulin Li, Yuanmei He. Risk factors for multiple organ dysfunction syndrome in patients with bee sting injury [J]. Chinese Journal of Clinicians(Electronic Edition), 2023, 17(9): 1010-1015.
[11]	Jun Wang, Kunpeng Liu, Lan Yao, Hua Zhang, Yue Wei, Libin Suo, Jun Chen, chengli Miao, Chenghua Luo. Retrospective analysis of anesthesia management of massive transfusion patients undergoing retroperitoneal tumor resection [J]. Chinese Journal of Clinicians(Electronic Edition), 2023, 17(08): 844-849.
[12]	Da Li, Daya Zhang, Runxiang Chen, Xiaodong Zhang, Shimei Huang, Chen Chen, fan Zeng, Shiju Chen, Feihu Bai. Epidemiological characteristics and risk factors of Helicobacter pylori infection in Dongfang city of Hainan province [J]. Chinese Journal of Clinicians(Electronic Edition), 2023, 17(08): 858-864.
[13]	Zhenshuang Du, Qingfu Hu, Yingyi Lin, Yuexia Zhang, Meili Chen, Yiqi Li, Zhenhua Wang. Factors influencing motivation of community general practitioners [J]. Chinese Journal of Clinicians(Electronic Edition), 2023, 17(08): 876-883.
[14]	Libin Suo, Kunpeng Liu, Lan Yao, Hua Zhang, Yue Wei, Jun Wang, Jun Chen, Chengli Miao, Chenghua Luo. Key points of anesthesia management and prognostic factors in patients undergoing primary retroperitoneal paraganglioma resection [J]. Chinese Journal of Clinicians(Electronic Edition), 2023, 17(07): 771-776.
[15]	Qi Li, Zhongying Huang, Ping Yuan, Zhenpeng Guan. Analysis of factors influencing nosocomial infection with multi-drug resistant bacteria in intensive care unit of a tertiary hospital [J]. Chinese Journal of Clinicians(Electronic Edition), 2023, 17(07): 777-782.

Please choose a citation manager

Content to export