肝移植患者术后延迟拔管的相关因素及短期结局分析

doi:10.3969/j.issn.1009-976X.2026.03.003

摘要/Abstract

摘要： 目的探讨肝移植患者术后延迟拔管的相关因素及其与短期结局的关系。方法采用单中心回顾性队列研究,纳入2021年1月至2023年12月接受肝移植手术的患者。以气管导管保留总时长>24 h定义为延迟拔管。收集患者基线资料及围术期指标。主要结局为ICU停留时间,次要结局为呼吸道感染。采用Logistic回归分析延迟拔管相关因素,采用负二项回归分析延迟拔管与ICU停留时间的关系。结果共纳入180例患者,其中延迟拔管108例（60.0%）,非延迟拔管72例（40.0%）。延迟拔管相关因素的单因素分析显示,延迟拔管组输血总量和手术时间均高于非延迟拔管组（均P<0.001）;多因素Logistic回归分析显示,手术总时长与延迟拔管独立相关,每增加100 min,延迟拔管发生风险增加（OR=2.21,95%CI：1.34~3.66,P=0.002）。主要结局方面,延迟拔管组ICU停留时间长于非延迟拔管组〔9.0（7.0,13.0）d比6.0（5.0,8.0）d,P<0.001〕;负二项回归分析显示,延迟拔管与ICU停留时间延长独立相关（IRR=1.36,95%CI：1.11~1.66,P=0.003）。次要结局方面,延迟拔管组与非延迟拔管组呼吸道感染发生率分别为15.7%和6.9%,差异无统计学显著性（P=0.104）。结论较长手术总时长与延迟拔管相关,延迟拔管与ICU停留时间延长相关,但与呼吸道感染未见统计学显著关联。

关键词: 肝移植, 延迟拔管, ICU停留时间, 呼吸道感染, 围术期管理

Abstract: Objective To investigate factors associated with delayed extubation after liver transplantation and its relationship with short-term outcomes. Methods This single-center retrospective cohort study included patients who underwent liver transplantation between January 2021 and December 2023. Delayed extubation was defined as a total endotracheal tube retention time of >24 h. Baseline characteristics and perioperative variables were collected. The primary outcome was ICU length of stay, and the secondary outcome was respiratory tract infection. Logistic regression was used to identify factors associated with delayed extubation, and negative binomial regression was used to assess the association between delayed extubation and ICU length of stay. Results A total of 180 patients were included, of whom 108 patients （60.0%） experienced delayed extubation and 72 （40.0%） did not. Compared with the non-delayed extubation group, the delayed extubation group had greater transfusion volume and longer operation time （both P<0.001）. Multivariable logistic regression showed that operation time was independently associated with delayed extubation; for every 100-min increase in operation time, the risk of delayed extubation increased （OR=2.21, 95%CI： 1.34~3.66, P=0.002）. For the primary outcome, ICU length of stay was longer in the delayed extubation group than in the non-delayed extubation group [9.0（7.0,13.0） d vs. 6.0（5.0,8.0） d, P<0.001]. Negative binomial regression showed that delayed extubation was independently associated with a longer ICU stay（IRR=1.36, 95%CI： 1.11~1.66, P=0.003）. For the secondary outcome, respiratory tract infection occurred in 15.7% of patients in the delayed extubation group and 6.9% in the non-delayed extubation group, with no statistically significant difference （P=0.104）. Conclusion Longer operation time was associated with delayed extubation, and delayed extubation was associated with longer ICU stay, whereas no statistically significant association was observed with respiratory tract infection.

Key words: liver transplantation, delayed extubation, ICU length of stay, respiratory tract infection, perioperative management

中图分类号:

丁育, 林倩, 曾毅涛, 张克林, 赵海璇. 肝移植患者术后延迟拔管的相关因素及短期结局分析[J]. 岭南现代临床外科, 2026, 26(03): 154-160.

DING Yu, LIN Qian, ZENG Yitao, ZHANG Kelin, ZHAO Haixuan. Factors associated with delayed extubation after liver transplantation and short-term outcomes[J]. Lingnan Modern Clinics In Surgery, 2026, 26(03): 154-160.

参考文献

[1] Pollok JM, Tinguely P, Berenguer M, et al.Enhanced recovery for liver transplantation: recommendations from the 2022 International Liver Transplantation Society consensus conference[J]. Lancet Gastroenterol Hepatol, 2023, 8(1): 81-94.
[2] Brustia R, Monsel A, Skurzak S, et al.Guidelines for Perioperative Care for Liver Transplantation: Enhanced Recovery After Surgery (ERAS) Recommendations[J]. Transplantation, 2022, 106(3): 552-561.
[3] Tinguely P, Badenoch A, Krzanicki D, et al.The role of early extubation on short-term outcomes after liver transplantation - A systematic review, meta-analysis and expert recommendations[J]. Clin Transplant, 2022, 36(10): e14642.
[4] 韦玉枝, 张欢, 王琳琳, 等. 肝移植患者术后气管导管延迟拔管的危险因素[J]. 临床麻醉学杂志, 2023, 39(06): 571-576.
[5] 徐艳, 刘馨, 姜春玲. 加速康复外科理念下肝移植手术患者围手术期早期拔管的发展及应用[J]. 中国中西医结合急救杂志, 2022, 29(06): 746-749.
[6] Haque ME, Badenoch AD, Orlov D, et al.Predicting Early Extubation After Liver Transplantation: External Validation and Improved Generalizability of a Proposed Fast-track Score[J]. Transplantation, 2021, 105(9): 2029-2036.
[7] Suphathamwit A, Pongraweewan O, Lakkam S, et al.Predictive score for immediate extubation after liver transplantation[J]. Clin Transplant, 2021, 35(3): e14212.
[8] Acho C, Morita Y, Fernandez V, et al.Immediate Postoperative Extubation Decreases Pulmonary Complications in Liver Transplant Patients[J]. Transplantation, 2021, 105(9): 2018-2028.
[9] Tinguely P, Morare N, Ramirez-Del Val A, et al. Enhanced recovery after surgery programs improve short-term outcomes after liver transplantation-A systematic review and meta-analysis[J]. Clin Transplant, 2021, 35(11): e14453.
[10] Lee S, Sa GJ, Kim SY, et al.Intraoperative predictors of early tracheal extubation after living-donor liver transplantation[J]. Korean J Anesthesiol, 2014, 67(2): 103-109.
[11] Jeon S, Lim DG, Kim H, et al.Relevant clinical factors for early extubation in living-donor liver transplantation: A single-center retrospective cohort study[J]. World J Clin Cases, 2025, 13(14): 102693.
[12] Lacom C, Kothari RP, Mendez NV, et al.Safety and Feasibility of Early Extubation in Liver Transplantation: Experience in 1555 Patients[J]. Transplantation, 2025, 109(8): 1393-1401.
[13] Yoon JP, Yoon JP, Kim HJ, et al.Effects of immediate extubation in the operating room on long-term outcomes in living donor liver transplantation: a retrospective cohort study[J]. Anesth Pain Med (Seoul), 2025, 20(1): 50-60.
[14] Huang CT, Lin HC, Chang SC, et al.Pre-operative risk factors predict post-operative respiratory failure after liver transplantation[J]. PLoS One, 2011, 6(8): e22689.
[15] Papazian L, Klompas M, Luyt CE.Ventilator-associated pneumonia in adults: a narrative review[J]. Intensive Care Med, 2020, 46(5): 888-906.
[16] 蔡腊梅, 徐艳, 匡姝瑜, 等. 成人肝移植术后非手术室拔管的危险因素[J]. 临床麻醉学杂志, 2022, 38(08): 820-824.
[17] 尹增明, 方亮. 肝移植患者术后营养不良的影响因素分析[J]. 中国医药导报, 2026, 23(2): 77-83+106.
[18] 肖海英, 冉敏, 朱泊羽, 等. 我国肝移植受者围术期体质量变化特征及影响因素分析[J]. 重庆医科大学学报, 2026,51(7):928-933.
[19] Klompas M, Branson R, Cawcutt K, et al.Strategies to prevent ventilator-associated pneumonia, ventilator-associated events, and nonventilator hospital-acquired pneumonia in acute-care hospitals: 2022 Update[J]. Infect Control Hosp Epidemiol, 2022, 43(6): 687-713.
[20] 崔丽娜, 魏昌伟, 吴丹, 吴安石. 肝移植手术后肺部感染的危险因素分析[J]. 临床麻醉学杂志, 2024, 40(1): 13-17.