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| 成人肝移植新肝期低体温对预后的影响 |
| Effect of hypothermia in reperfusion stage on prognosis during adult liver transplantation |
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| DOI： |
| 中文关键词: 肝移植 低体温 缺血-再灌注 |
| 英文关键词: Liver transplantation Hypothermia Ischemia-reperfusion |
| 基金项目:天津市卫生行业重点攻关项目 (13KG105,16KG101);天津市自然科学基金 (17JCYBJC28000);天津医学会麻醉学分会中青年科研培育基金项目 (TJMZJJ-2016-01) |
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| 中文摘要: |
| 目的 观察成人肝移植围术期体温变化趋势及术中新肝期低体温对患者预后的影响。方法 回顾性分析我院2015年1月至2016年12月行肝移植术的成人患者107例，男62例，女45例，年龄25～65岁， ASA Ⅲ或Ⅳ级。记录麻醉诱导后 (T0)、切皮即刻 (T1)、无肝期即刻 (T2)、门静脉开放即刻 (T3)、开放后5 min (T4)、关腹即刻 (T5)、出室 (T6)时的体温，观察其总体体温变化趋势。以再灌注期核心体温<35℃且持续时间>5 min者为低体温组，再灌注期核心体温≥35℃或体温＜35℃但持续时间<5 min者为正常体温组，比较两组患者术中出血量、尿量、术后拔管时间、ICU停留时间和住院时间，分析新肝期 (T4～T6)体温对患者手术及预后的影响，并进行低体温持续时间与预后的相关性分析。结果 肝移植围术期体温总体呈现先下降 (T0～T4)后上升 (T4～T6)的变化趋势，T4时体温降至最低，为（34.8±0.6）℃，低于正常体温 (35.0℃)，此时处于身体的低体温状态。与T0时比较，T2～T5时体温明显降低（P<0.05）。与正常体温组比较，低体温组出血量明显增多，术后拔管时间明显延长 (P<0.05)。两组患者尿量、ICU停留时间及住院时间差异无统计学意义。术中低体温持续时间与出血量、拔管时间、ICU停留时间呈正相关，与尿量呈负相关，与住院时间无明显相关性。结论 肝移植再灌注期低体温会增加患者出血量，延长术后拔管时间;低体温持续时间越长，越不利于患者预后。 |
| 英文摘要: |
| Objective To observe the effect of hypothermia in reperfusion stage on prognosis during adult liver transplantation. Methods Data of 107 patients (62 males, 45 females, aged 25-65 years, ASA physical status Ⅲ or Ⅳ) underwent adult liver transplantation from January 2015 to December 2016 in our hospital were retrospectively analyzed. The temperature at the time of anesthesia induction (T0), skin incision (T1), anhepatic phase immediately (T2), immediate reperfusion (T3), 5 min after reperfusion (T4), abdomen-closing (T5) and the end of surgery (T6) were recorded to observe the trend of overall temperature change. Patients were devided into normal temperature group (core temperature was≥35℃ or <35℃ but the duration was less than 5 min in reperfusion period) and hypothemia group (core body temperature was <35℃ and the duration was>5 min) to compare difference between the two groups of perioperative blood loss, urine volume, postoperative extubation time, ICU staying time and hospitalization time. The influence of hypothermia during the new liver phase (T4-T6) on prognosis and correlation between duration of hypothermia and blood loss, urine volume, postoperative extubation time, ICU staying time and hospitalization time were analyzed. Results This study found that during the perioperative adult liver transplantation, the body temperature showed a decreasing trend first (T0-T4) and then an increasing one (T4-T6). The body temperature droped to the lowest at T4, which was lower than the normal body temperarure [(34.8±0.6) ℃ vs 35.0 ℃]. Compared with T0, the temperature decreased obviously at T2-T5 (P<0.05); Compared to normal temperature group, the amount of bleeding was more and the extubation time was longer in hypothermia group (P<0.05), and there was no significant difference in urine volume, ICU staying time and hospitalization time between the two groups. There were positive correlations between the time of hypothermia and bleeding, extubation time, ICU staying time and negative correlations with urine output, while no obvious relations with postoperative hospital staying time. Conclusion During the perioperative liver transplantation, hypothermia increased the blood loss and postoperative extubation time. The longer the hypothermia time is, the poorer the prognosis is. |
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