肝移植后长期使用重症监护的早期预测因素
Hunter B Moore1, Wells LaRiviere2, Ivan Rodriguez3
1Department of Surgery, Division of Transplant Surgery, University of Colorado, USA; Colorado Center for Transplantation Care, Research, and Education, Aurora, CO, USA; Department of Surgery, Division of Transplant Surgery, Children's Hospital Colorado, USA.
American journal of surgery
|August 21, 2023
概括
术后第一天肌氨酸升高和纤维解质抗性降低预测了肝移植后长时间的重症监护室停留. 这些因素还表明,在90天内,移植损失的风险更高.
科学领域:
- 移植医学 移植医学
- 关键护理医学 关键护理医学
- 实验室医学 实验室医学
背景情况:
- 肝移植 (LT) 后在重症监护室 (pICU) 长时间停留与多器官功能障碍有关.
- 肌素,胆红素和纤维溶解耐药性是pICU的潜在危险因素.
- 早期预测pICU可以优化患者管理和结果.
研究的目的:
- 确定术后第一天 (POD-1) 实验室值是否可以预测LT接受者的pICU.
- 为了研究POD-1肌素,胆红素和纤维解析耐药性 (LY30) 与pICU之间的联系.
- 评估这些预测因素与90天移植损失之间的关系.
主要方法:
- 对304 LT接收者的回顾性分析.
- 收集POD-1临床实验室数据和粘弹性测试 (tPA TEG) 来检测纤维解质耐药性 (LY30).
- 后勤回归分析以确定pICU的预测因素 (定义为ICU≥7天).
主要成果:
- 15%的LT接受者经历了pICU. 15%的LT接受者经历了pICU.
- 较高的肌素 (OR 6.6) 和较低的tPA TEG LY30 (OR 3.7) 是pICU的独立预测因素.
- 患有这些风险因素的患者90天移植损失率增加了9倍 (19%vs2%).
结论:
- 在POD-1上,肌素升高和纤维素分解受损是LT后pICU的显著预测因素.
- 这些实验室标记与不良结果有关,包括长时间的ICU停留和增加的移植损失.
- 早期识别这些风险因素可以指导临床决策,并改善移植后的护理.
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