Pulmonary Complications After Elective Liver Transplantation-Incidence, Risk Factors, and Outcome
Pulmonary Complications After Elective Liver Transplantation-Incidence, Risk Factors, and Outcome
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DOI：
10.1097/tp.0b013e31825c1d41
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发表时间：
2012-09-15
期刊：
影响因子：
6.2
通讯作者：
Samuel, Didier
中科院分区：
文献类型：
--
作者：
Levesque, Eric;Hoti, Emir;Samuel, Didier
肝移植(LT)后，大约35%至50%的受者会发生术后肺部并发症(PPC)。其中肺炎是最常见的PPC。在等待LT的患者中，肺功能障碍也得到了广泛的报道。这种功能障碍与PPC之间的联系尚不清楚。在这项队列研究中，我们评估了肝移植术后肺炎的发生率和概况，并确定了潜在的术前危险因素。对2008年1月至2010年4月212例肝移植患者的术后临床资料进行分析。这些患者在单一的重症监护病房接受治疗，并接受标准化的术后护理。在术后期间，47例(22%)患者发展为肺炎，其中20例(43%)发展为呼吸衰竭，需要机械通气。单因素分析显示，术前多项因素(受者年龄、终末期肝病评分模式、肝移植适应证、血小板计数、术前肺功能检查显示的限制性肺类型)和术中输血(输血单位和新鲜冰冻血浆单位)与肺炎的发生有关。Logistic回归多因素分析显示，限制性肺型(优势比3.14，95%可信区间1.5 1~6.5 1，P=0.002)和移植前测量的国际标准化比(OR=4.95，95%可信区间1.86~8.5 9，P=0.0004)是术后肺炎的独立预测因素。肺炎在接受肝移植的患者中很常见，也是发病率的主要原因。术前肺部检查的限制性模式和在肝移植前测量的较高的国际标准化比率与术后肺炎的风险更高相关。
After liver transplantation (LT), postoperative pulmonary complications (PPC) occur in approximately 35% to 50% of the recipients. Among these PPC, pneumonia is the most frequently encountered. Pulmonary dysfunction has also been widely reported among patients awaiting LT. The links between this dysfunction and PPC have not been clearly established. In this present cohort study, we evaluated the incidence and profile of post-LT pneumonia and identified potential preoperative risk factors.Methods. The postoperative clinical course of 212 liver transplant recipients between January 2008 and April 2010 was analyzed. These patients were treated in a single intensive care unit and received standardized postoperative care.Results. During the postoperative period, 47 (22%) patients developed pneumonia, of whom 20 (43%) developed respiratory failure requiring mechanical ventilation. Univariate analysis showed that several preoperative factors (age of recipient, model for end-stage liver disease score, indication for LT, platelet count, and restrictive lung pattern revealed by preoperative pulmonary function tests) and the transfusion (blood units and fresh frozen plasma units) during the operative period were associated with pneumonia. Using multivariate analysis by logistic regression, only a restrictive lung pattern (odds ratio=3.14; 95% confidence interval, 1.51-6.51; P=0.002) and the international normalized ratio measured prior LT (OR=4.95; 95% confidence interval, 1.86-8.59; P=0.0004) were independent predictors of pneumonia after LT.Conclusion. Pneumonia is common among patients undergoing LT and is a major cause of morbidity. A restrictive pattern on preoperative pulmonary testing and a higher international normalized ratio measured prior LT were associated with more risk of postoperative pneumonia.