高海拔适应作为肝切除术后肺部并发症的保护因素:一项前性匹配队列研究
Qingyong Luo1, Yu Zhang2, Shiyao Gu3
1Department of Anesthesiology, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, 610072, China.
高海拔适应 (HAA) 显著减少肝切除后的术后肺部并发症 (PPC). 高海拔地区的居民体验到更少的PPC和更短的住院时间,这表明HAA提供了保护性的好处.
科学领域:
- 心脏病学 心脏病学
- 肺部医学 肺部医学
- 外科手术的结果
背景情况:
- 高海拔适应 (HAA) 是对慢性缺氧的反应,具有心脏保护作用.
- 肝切除后HAA对术后肺部并发症 (PPC) 的影响尚未得到充分证实.
研究的目的:
- 调查HAA与肝切除术患者中PPC发生率和严重程度之间的关联.
- 确定HAA对外科手术后期结果影响的潜在机制.
主要方法:
- 一个单中心前性匹配队列研究包括292名接受选择性肝切除的患者.
- 患者被分为高海拔 (≥1500m) 和平原 (<1500m) 的两组.
- 倾向性得分匹配 (1:2) 用于控制混因素,以PPC在7天内作为主要结果.
主要成果:
- 对212名患者的匹配分析显示,在高海拔组中,PPC的发病率明显较低 (61.5%与76.1%,P=0.024).
- 高海拔组经历了较轻的并发症严重程度和较短的住院时间 (6对7天,P=0.005).
- 鉴定出HAA是PPC的独立保护因子 (OR 0.31,P=0.020),在手术期间血糖更稳定,乳酸积累更少.
结论:
- 肝切除术后,HAA可能会降低PPC的发生率和严重程度.
- 增强的新陈代谢稳定性,特别是血糖调节和乳酸水平在肝关闭期间,可能有助于这些保护作用.
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