Risk factors for postoperative pulmonary infection undergoing liver transplantation / 临床麻醉学杂志

ABSTRACT

Objective To investigate the risk factors for postoperative pulmonary infection in pa-tients undergoing liver transplantation.Methods Clinical data of 1 358 patients who underwent liver trans-plantation for the first time from June 2005 to June 2013 at three clinical medical centers were retrospectively analyzed.Patients were divided into two groups according to whether or not they developed lung infection within 30 days after surgery:the infection group and the non-infection group.General,intrao-perative and postoperative data were collected,and risk factors for pulmonary infection after liver transplan-tation were analyzed using univariate analysis and binary logistic regression.Results Lung infections after liver transplantation occurred in 316 patients(23.3%),of whom 21 patients(6.7%)died.Compared with the non-infection group,the proportion of preoperative diagnosis of chronic severe hepatitis,hepatocellular carcinoma,hepatitis C cirrhosis,congenital liver disease and liver failure,preoperative combined hepatore-nal syndrome,hepatic coma and diabetes mellitus,preoperative creatinine concentration were significantly increased in the infection group(P＜0.05),preoperative total protein and albumin concentrations were significantly decreased(P＜0.05),and the duration of the hepatic-free period,the duration of postoperative awakening,and the duration of postoperative extubation were significantly prolonged(P＜0.05),intraoperative blood loss was significantly increased(P＜0.05),intraoperative urine output was significantly decreased(P＜0.05),the proportion of intraoperative phenylephrine,atropine,lidocaine,and furosemide drugs were significantly decreased(P＜0.05),and postoperative mortality rate was signifi-cantly increased in the infection group(P＜0.05).The results of binary logistic regression analysis showed that chronic severe hepatitis,hepatitis C cirrhosis,liver failure,preoperative diabetes mellitus,intraopera-tive blood loss＞1 900 ml,and postoperative awakening time＞7.3 hours were the risk factors for postoper-ative pulmonary infections in liver transplant patients,and the surgical method(classical non-transfusion in situ liver transplantation),the use of lidocaine during surgery,preoperative total protein＞64.6 g/L,and intraoperative urine volume＞1 800 ml were protective factors for postoperative pulmonary infections in liver transplantation patients.Conclusion Preoperative diagnosis of chronic severe hepatitis,hepatitis C cirrho-sis,liver failure,preoperative combined diabetes mellitus,intraoperative blood loss＞1 900 ml,and post-operative awakening time＞7.3 hours are risk factors for pulmonary infection after liver transplantation.