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加速康复外科方案改善肝移植受者结局

黎利娟 陆平兰 周密 贡旭楠 刘剑戎 陈规划 易慧敏 吕海金

黎利娟, 陆平兰, 周密, 等. 加速康复外科方案改善肝移植受者结局[J]. 器官移植, 2020, 11(1): 66-71, 103. doi: 10.3969/j.issn.1674-7445.2020.01.010
引用本文: 黎利娟, 陆平兰, 周密, 等. 加速康复外科方案改善肝移植受者结局[J]. 器官移植, 2020, 11(1): 66-71, 103. doi: 10.3969/j.issn.1674-7445.2020.01.010
Li Lijuan, Lu Pinglan, Zhou Mi, et al. Enhanced recovery after surgery improves clinical outcomes of liver transplant recipients[J]. ORGAN TRANSPLANTATION, 2020, 11(1): 66-71, 103. doi: 10.3969/j.issn.1674-7445.2020.01.010
Citation: Li Lijuan, Lu Pinglan, Zhou Mi, et al. Enhanced recovery after surgery improves clinical outcomes of liver transplant recipients[J]. ORGAN TRANSPLANTATION, 2020, 11(1): 66-71, 103. doi: 10.3969/j.issn.1674-7445.2020.01.010

加速康复外科方案改善肝移植受者结局

doi: 10.3969/j.issn.1674-7445.2020.01.010
基金项目: 

广东省科技计划项目 2017B020209004

详细信息
    作者简介:

    黎利娟,女,1985年生,硕士,主治医师,研究方向为危重症诊治,Email:lilijuan3@mail.sysu.edu.cn

    通讯作者:

    吕海金,男,1983年生,博士研究生,主治医师,研究方向为干细胞临床研究,Email:lvhaijin@mail.sysu.edu.cn

  • 中图分类号: R617, R619

Enhanced recovery after surgery improves clinical outcomes of liver transplant recipients

More Information
  • 摘要:   目的  探讨加速康复外科(ERAS)方案在肝移植受者中实施的合理性及有效性。  方法  回顾性分析465例肝移植受者的临床资料。根据有否接受ERAS方案治疗将受者分为ERAS组(163例)和对照组(302例),ERAS组病情重于对照组。观察并记录肝移植受者的手术情况,包括手术时间、无肝期、术中输血量;记录肝移植受者的术后恢复情况,包括术后重症监护室(ICU)住院时间、总住院时间、术后28 d总撤除呼吸机时间、术后再插管率;记录肝移植受者术后90、180 d及1年的生存率,分析肝移植受者生存率的影响因素。  结果  ERAS组受者的无肝期为45(39,53)min, 明显长于对照组的40(32,48)min(P < 0.05)。ERAS组红细胞输注量为10(7,13)U,明显少于对照组的18(10,28)U(P < 0.05)。ERAS组受者的术后ICU住院时间、总住院时间分别为135(84,212)h、24(18,33)d,均短于对照组的154(103,253)h、34(20,50)d(均为P < 0.05)。ERAS组受者的术后28 d总撤除呼吸机时间为26(25,27) d,明显长于对照组的26(23,27) d(P < 0.05)。ERAS组受者的术后再插管率为11.0%,明显低于对照组的20.8%(P < 0.05)。ERAS组受者术后90、180 d以及1年的生存率均为92.8%,均明显高于对照组受者的81.1%、78.1%、75.7%(均为P < 0.05)。ERAS和手术时间是肝移植受者生存率的独立影响因素(P < 0.05)。  结论  肝移植术后ERAS管理模式可提高受者生存率,同时可缩短受者的住院时间、降低再插管率,对肝移植术后康复具有积极的促进作用。

     

  • 图  1  两组受者肝移植术后1年的生存曲线

    Figure  1.  Survival curves of recipients within 1 year after liver transplantation in 2 groups

    表  1  肝移植受者生存率影响因素的单因素和多因素分析

    Table  1.   Univariate and multivariate analysis of influencing factors for survival rate of recipients after liver transplantation

    影响因素 单因素分析 多因素分析
    HR (95%CI P HR(95%CI P
    肾衰竭
      否 1 1
      是 1.58 (0.97~2.57) 0.067 7 1.86 (0.98~3.50) 0.055 7
    手术时间 1.23 (1.08~1.40) 0.001 9 1.26 (1.10~1.45) 0.001 2
    分组
      对照组 1 1
      ERAS组 0.30 (0.15~0.58) 0.000 4 0.25 (0.12~0.51) 0.000 1
    MELD评分 1.01 (0.99~1.03) 0.364 9 1.01 (0.98~1.04) 0.381 0
    合并肿瘤
      0 1 1
      1 1.06 (0.65~1.73) 0.807 9 1.33 (0.71~2.49) 0.381 3
    无肝期 1.00 (0.98~1.02) 0.750 6 1.00 (0.97~1.02) 0.701 7
    ACLF 3级
      0 1 1
      1 0.95 (0.58~1.56) 0.836 2 0.77 (0.33~1.79) 0.538 5
    脑衰竭
      否 1 1
      是 1.01 (0.63~1.63) 0.952 2 1.13 (0.53~2.41) 0.753 5
    既往腹部手术病史
      0 1 1
      1 1.06 (0.63~1.78) 0.836 3 0.85 (0.48~1.49) 0.564 7
    注:①HR为风险比。
    CI为可信区间。
    下载: 导出CSV
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出版历程
  • 收稿日期:  2019-10-05
  • 网络出版日期:  2021-01-19
  • 刊出日期:  2020-01-15

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