Risk factors for perioperative hypotension in severe patients after liver cancer surgery / 临床肝胆病杂志

ABSTRACT

Objective To investigate the risk factors for perioperative hypotension in severe patients after liver cancer surgery and its influence on prognosis. Methods A retrospective analysis was performed for the clinical data of 422 patients who underwent surgical treatment due to primary liver cancer or metastatic liver cancer and were then admitted to the intensive care unit (ICU) of Peking University People's Hospital from January 2014 to December 2019. The 107 patients requiring continuous intraoperative or postoperative pumping of vasoactive drugs (norepinephrine, dopamine, phenylephrine, and epinephrine) to maintain blood pressure were included in the hypotension group, and the 315 patients who did not require the pumping of vasoactive drugs to maintain blood pressure were included in the non-hypotension group. Related clinical data were collected from all patients, including sex, age, body mass index, history of liver surgery, comorbidities, underlying liver diseases, preoperative laboratory examinations, surgical data, and anesthesia, and the two groups were compared in terms of related prognostic indicators (in-hospital mortality, length of ICU stay, length of hospital stay, duration of mechanical ventilation, acute kidney injury, hypoxemia, pulmonary infection, and myocardial injury). The independent samples t -test was used for comparison of normally distributed continuous data between two groups, and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups; the chi-square test was used for comparison of categorical data between two groups. The clinical indices with P < 0.1 were included in the binary logistic regression analysis to investigate the risk factors for hypotension. Results The overall mortality rate was 1.9% for the severe patients after liver cancer surgery, with a mortality rate of 3.7% in the hypotension group and 1.3% in the non-hypotension group. Compared with the non-hypotension group, the hypotension group had a significantly longer length of ICU stay ( Z =-6.440, P < 0.001), a significantly longer duration of mechanical ventilation ( Z =-6.082, P < 0.001), and a significantly higher proportion of patients with acute kidney injury, hypoxemia, and pulmonary infection after surgery ( χ 2 =25.661, 25.409, and 20.126, all P < 0.001). The clinical indices with P < 0.1 between the two groups (coronary heart disease, ascites, preoperative levels of albumin/platelets/fibrinogen, time of operation and hepatic portal occlusion, laparotomy, blood loss) were included in the binary logistic regression analysis, and the results showed that time of operation (odds ratio [ OR ]=1.004, 95% confidence interval [ CI ]: 1.002-1.006, P < 0.05) and blood loss ( OR =1.151, 95% CI : 1.009-1.313, P < 0.05) were independent risk factors for hypotension in patients undergoing liver cancer surgery, while preoperative albumin level ( OR =0.950, 95% CI : 0.907-0.995, P < 0.05) was a protective factor. Conclusion There is a relatively high incidence rate of hypotension among severe patients after liver cancer surgery, and a longer time of operation and greater blood loss are independent risk factors for hypotension, while a higher preoperative albumin level is a protective factor.