预判性体外膜肺氧合术中支持在高危肝移植受者中的应用研究

A study on the application of predictive extracorporeal membrane oxygenation intraoperative support in high-risk liver transplant recipients

摘要

目的 探讨预判性体外膜肺氧合术中支持在高危肝移植受者中的临床安全性及有效性。方法 采用单中心回顾性研究，纳入广西医科大学第二附属医院2021年1月至2025年4月术中预判性接受体外膜肺氧合（ECMO）辅助的35例肝移植受者。分析受者基线特征、ECMO应用情况、ECMO运行参数及ECMO运行期间血流动力学情况，采用Kaplan-Meier法计算累积生存率并绘制生存曲线。结果 35例受者于全身麻醉诱导后建立静脉-动脉ECMO，ECMO中位运行时间为8.5 h，撤机成功率97%。受者无肝期及新肝期心脏指数（CI）均高于置管前，CI在无肝期和撤机前均升高（均为 P<0.001），有创平均动脉压与中心静脉压保持平稳。受者均未发生ECMO相关并发症，平均生存时间为（25±3）个月，主要死亡原因为重症肺部感染和多器官衰竭。结论 对于合并严重心肺功能不全、血流动力学紊乱或多器官衰竭高危因素的肝移植受者，通过主动预判风险，有指征者在肝移植手术中预判性实施ECMO支持是一种安全且有效的循环保障方案。

Abstract

Objective To investigate the clinical safety and efficacy of predictive extracorporeal membrane oxygenation (ECMO) support during liver transplantation in high-risk recipients. Methods A single-center retrospective study was conducted. A total of 35 liver transplant recipients who underwent predictive ECMO assistance during surgery at the Second Affiliated Hospital of Guangxi Medical University from January 2021 to April 2025 were included. Baseline characteristics, ECMO application, ECMO operating parameters and hemodynamic conditions during ECMO operation were analyzed. The cumulative survival rate was calculated using the Kaplan-Meier method and survival curves were plotted. Results Veno-arterial ECMO in 35 recipients was established after induction of general anesthesia. The median ECMO operation time was 8.5 h, and the success rate of weaning from ECMO was 97%. The cardiac index (CI) during the non-liver period and the new liver period was higher than that before cannulation, and CI increased during the non-liver period and before weaning (all P<0.001). The mean invasive arterial pressure and central venous pressure remained stable. No ECMO-related complications occurred in the recipients. The average survival time was (25 ± 3) months. The main causes of death were severe pulmonary infection and multiple organ failure. Conclusions For liver transplant recipients with severe cardiopulmonary dysfunction, hemodynamic disorders, or multiple organ failure risk factors, implementing predictive ECMO support during liver transplantation through active risk prediction is a safe and effective circulatory guarantee strategy.

关键词

体外膜肺氧合 / 肝移植 / 高危患者 / 预判性支持 / 终末期肝病模型 / 心排出量 / 心脏指数 / 活化凝血时间

Key words

Extracorporeal membrane oxygenation / Liver transplantation / High-risk patient / Predictive support / Model for end-stage liver disease / Cardiac output / Cardiac index / Activated clotting time

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基金资助

广西医疗卫生适宜技术开发与推广应用项目(S2023079)