Severe Intraoperative Hyperglycemia Is Independently Associated With Surgical Site Infection After Liver Transplantation
Severe Intraoperative Hyperglycemia Is Independently Associated With Surgical Site Infection After Liver Transplantation
复制标题
术中严重高血糖与肝移植后手术部位感染独立相关
作者：
Chulsoo Park;Che;G. Neelakanta;H. Nourmand;M. Braunfeld;C. Wray;R. Steadman;K. Hu;R. Cheng;V. Xia
背景手术部位感染（SSI）是一种常见的术后并发症，与接受肝移植（LT）的患者的发病率和死亡率增加相关。尽管术中高血糖已被证明与不良术后结局相关，包括LT患者的总体感染率，但术中高血糖与LT中SSI之间的关系尚未确定。我们试图确定术中高血糖是否与LT后SSI相关。2004年1月至2007年11月在我们医疗中心接受LT的患者被纳入研究。回顾性分析了患者、供体和术中变量，包括各种葡萄糖指数。SSI的独立危险因素采用多变量logistic回归模型进行识别。结果在680例患者中，76例（11.2%）发生术后SSI。在分析的所有术中血糖指数中，重度高血糖（≥200 mg/dL）与术后SSI独立相关（比值比[OR] 2.25，95%置信区间[CI] 1.26-4.03，P=0.006）。其他独立风险因素包括重复手术（OR 6.58，95%CI 3.41-12.69，P<0.001），术中应用血管加压药（OR 3.14，95%CI 1.65-5.95，P<0.001），术前机械通气（OR 3.01，95% CI 1.70-5.33，P<0.001），肝肾联合移植（OR 2.95，95% CI 3.41-12.69，P<0.001）。结论.重度（而非轻度或中度）术中高血糖与术后SSI独立相关，应在LT手术期间避免。
Background. Surgical site infection (SSI) is a common postoperative complication associated with increased morbidity and mortality in patients undergoing liver transplantation (LT). Although intraoperative hyperglycemia has been shown to be associated with adverse postoperative outcomes including overall infection rate in LT patients, a relationship between intraoperative hyperglycemia and SSI in LT has not been established. We sought to determine if intraoperative hyperglycemia was associated with SSI after LT. Methods. Patients undergoing LT at our medical center between January 2004 and November 2007 were included in the study. Recipient, donor, and intraoperative variables including a variety of glucose indices were retrospectively analyzed. Independent risk factors of SSI were identified using a multivariate logistic regression model. Results. Of 680 patients, 76 (11.2%) experienced postoperative SSIs. Among all intraoperative glucose indices analyzed, severe hyperglycemia (≥200 mg/dL) was independently associated with postoperative SSI (odds ratio [OR] 2.25, 95% confidence interval [CI] 1.26–4.03, P=0.006). Other independent risk factors include repeat surgery (OR 6.58, 95% CI 3.41–12.69, P<0.001), intraoperative administration of vasopressor (OR 3.14, 95% CI 1.65–5.95, P<0.001), preoperative mechanical ventilation (OR 3.01, 95% CI 1.70–5.33, P<0.001), and combined liver and kidney transplantation (OR 2.95, 95% CI 3.41–12.69, P<0.001). Conclusions. Severe, but not mild or moderate, intraoperative hyperglycemia is independently associated with postoperative SSI and should be avoided during LT surgery.
影响因子：
5.3
作者：
Olsen, Margaret A.;Nepple, Jeffrey J.;Fraser, Victoria J.
通讯作者：
Fraser, Victoria J.