2021 年第 3 期 第 16 卷

终末期肝病合并冠心病患者原位肝移植围术期主要不良心血管事件分析

Major adverse cardiovascular events during orthotopic liver transplantation perioperative period in patients with end-stage liver disease and coronary atherosclerotic heart disease

作者：王宁1张梁1金沐1李书闻2

英文作者：Wang Ning1 Zhang Liang1 Jin Mu1 Li Shuwen2

单位：1首都医科大学附属北京友谊医院麻醉科100050；2首都医科大学附属北京安贞医院麻醉中心100029

英文单位：1Department of Anethesiology Beijing Friendship Hospital Capital Medical University Beijing 100050 China; 2Anethesiology Center Beijing Anzhen Hospital Capital Medical University Beijing 100029 China

关键词：终末期肝病；冠心病（冠状动脉粥样硬化性心脏病）；肝移植

英文关键词：

• 摘要：

• 目的 对终末期肝病(ESLD)合并冠状动脉粥样硬化性心脏病患者行心脏死亡器官捐献（DCD）供肝原位肝移植术围术期主要不良心血管事件（MACE）进行分析，为此类患者预后判断和围术期处理措施优化提供依据。方法 收集首都医科大学附属北京友谊医院2015年5月至2018年12月收治的ESLD行DCD供肝成人原位肝移植术患者临床资料。纳入合并严重冠状动脉狭窄且未进行预防性冠状动脉血管重建的肝移植患者进行分析。主要研究目标是患者围术期MACE发生率；次要研究目标是患者术后30 d病死率、住院时间、非心脏手术后心肌损伤（MINS）等。结果 共收集359例ESLD行DCD供肝原位肝移植术患者，其中10例肝移植患者合并严重冠状动脉狭窄且未进行预防性冠状动脉血管重建，围术期MACE是急性心肌梗死1例。术后30 d内非心源性死亡2例。10例患者住院时间（19±7）d。6例患者发生MINS。Pearson相关性分析发现，术后患者心肌肌钙蛋白I水平与术后血乳酸水平呈正相关(r=0.800，P=0.031)。结论 合并有严重冠状动脉狭窄且未进行预防性冠状动脉血管重建的10例ESLD行DCD供肝原位肝移植术患者围术期MACE是急性心肌梗死1例，而6例患者发生MINS。多方面措施联合处理，注重预防为主的管理策略是保证此类患者手术成功的关键。

• Objective To investigate the major adverse cardiovascular events (MACE) during perioperative period of orthotopic liver transplantation (OLT) provided by donation after cardiac death (DCD) in patients with end-stage liver disease (ESLD) and coronary atherosclerotic heart disease, and to provide the basis for  prognosis judgment and perioperative management optimization of the patients. Methods The clinical data of adult patients with ESLD underwent OLT with DCD from May 2015 to December 2018 in Beijing Friendship Hospital, Capital Medical University were collected. Liver transplantation patients with severe coronary artery stenosis and without prophylactic coronary revascularization were included for analysis. The main objective was the occurrence of MACE during perioperative period; secondary objectives were mortality 30 d after operation, length of stay and myocardial injury after non-cardiac surgery(MINS). Results A total of 359 cases with ESLD underwent OLT with DCD. There were 10 cases with severe coronary artery stenosis and without prophylactic coronary revascularization underwent liver transplantation, and 1 case occurred perioperative MACE that was acute myocardial infarction. Non-cardiogenic death occurred in 2 cases within 30 d after operation. The hospitalization time of 10 cases was (19±7)d. The MINS occurred in 6 cases. Pearson correlation analysis showed that there was positive correlation between postoperative cardiac troponin I level and postoperative blood lactate level (r=0.800, P=0.031). Conclusions In 10 ESLD cases with severe coronary artery stenosis and without preventive coronary revascularization underwent OLT with DCD, perioperative MACE is acute myocardial infarction in 1 case, and MINS occurred in 6 cases. The key to ensure the success of this kind of patients is the combination of various measures and the management strategy focusing on prevention.