Abstract:

Objective To explore the risk factors affecting the survival rate of reintubation after liver transplantation，and to provide practical experience and theoretical basis for improving the survival rate of patients.Methods A retrospective analysis was performed on patients who underwent orthotopic liver transplantation in our hospital from January 2005 to December 2012. The patient's survival was calculated within three months after surgery. According to the survival condition at three months after operation，they were divided into survival groupand death group. The preoperative，intraoperative and donor liver parameters were compared between the two groups. The survival rate was used as the dependent variable. The included variables were analyzed by single factorand multivariate regression analysis，and the independent variables with significant influence on survival rate were selected. Results The survival rate of 55 patients with reintubation was 30.9%（17/55）. Preoperative model forend-stage liver disease（MELD）score（U ＝ 52.00，P ＜ 0.001），international normalized ratio（U ＝ 167.50，P ＜ 0.001），serum total bilirubin value（U ＝ 191.00，P ＝ 0.016），incidenceofpulmonaryinfection complicationin the death group（χ2 ＝5.30，P＝0.001）and theincidence ofascites complication（χ2 ＝ 5.33，P ＝ 0.001）were significantly higher than in the survival group. Age，preoperative serum creatinine level，portal vein thrombosis rate，incidence of pleural effusion，length of liver transplantation surgery，duration of anhepatic period，intraoperative blood loss，blood transfusion，warm ischemia time of donor liver and cold ischemia time were not statistical different. Regression analysis showed that the pulmonary infection comorbidity and MELD score remained in the logistic regression equation（OR ＝ 6.157，P ＝ 0.042 ；OR ＝ 1.312，P ＜0.001）were independent risk factors that affects the survival rate of reintubation. Conclusion For liver transplant recipients，preoperative MELD scoreand pulmonary infection comorbidity are independent risk factors for the survival rate of secondary tracheal intubation in the early postoperative period. Active control of pulmonary infection before surgery and efforts to reduce MELDscores can help improve survival.

Key words: Liver transplantation, Reintubation, Survival rate, Risk factors

摘要：

目的 探讨影响肝移植术后早期二次气管插管生存率的危险因素，为提高患者生存率提供实践经验和理论依据。方法 回顾性分析 2005 年 1 月—2012 年 12 月在武警总医院实施原位肝移植治疗并于术后早期接受二次气管插管患者的病例资料，统计术后 3 个月内患者生存情况，按照术后 3 个月时的生存情况分为生存组和死亡组。比较两组患者术前、术中及供肝等重要参数情况，将生存率作为因变量，对纳入的变量先后进行单因素和多因素回归分析，筛选出对生存率有显著影响的自变量。结果 本组 55 例二次插 管患者术后 3 个月时生存率为 30.9％（17/55）。死亡组术前终末期肝病模型（model for end stage liver disease，MELD）评分（U ＝ 52.00，P ＜ 0.001）、国际标准化比值（U ＝ 167.50，P ＜ 0.001）、血清总胆红素值（U ＝ 191.00，P ＝ 0.016）、肺部感染合并症发生率（χ2 ＝ 5.30，P ＝ 0.001）及腹水合并症发生率（χ2 ＝ 5.33，P ＝ 0.001）均显著高于生存组。年龄、术前血肌酐水平、门静脉血栓发生率、胸水发生率、肝移植手术时长和无肝期时长、术中出血量和输血量、供肝热缺血时间和冷缺血时间等在两组间均无统计学差异。回归分析结果显示肺部感染合并症与 MELD 评分（OR ＝ 6.157，P ＝ 0.042 ；OR ＝ 1.312，P ＜ 0.001）是影响二次插管生存率的独立危险因素。结论 对于肝移植受者，术前 MELD 评分及肺部感染合并症是影响术后早期二次气管插管生存率的独立危险因素。术前积极控制肺部感染并努力降低 MELD 评分有助于提高生存率。

关键词: 肝移植 , 二次气管插管 , 生存率 , 危险因素