背景:肝切除术后肝功能衰竭(PHLF)是肝切除术后最重要的死亡原因之一。肝素,一种既定的抗凝剂,可以通过多种机制保护肝功能,因此,预防肝功能衰竭。
目的:观察肝素预防肝切除术后肝功能障碍的安全性和有效性。
方法:数据是从重症监护III(MIMIC-III)v1中提取的。4位因肝癌而接受肝切除术的患者,将他们细分为两个队列:那些注射了肝素的人和那些没有注射的人。使用的统计评估是不成对t检验,Mann-WhitneyU测试,卡方检验,和Fisher的精确测试,以评估肝素给药对PHLF的影响,重症监护病房(ICU)住院时间,需要机械通风,使用连续性肾脏替代疗法(CRRT),低氧血症的发生率,急性肾损伤的发展,ICU死亡率。采用Logistic回归分析与PHLF、倾向评分匹配(PSM)旨在平衡两组之间的术前差异。
结果:在这项研究中,分析1388例接受肝癌肝切除术的患者。PSM从肝素治疗组和对照组中产生了213对匹配的对。初始单变量分析表明肝素潜在地降低了匹配和不匹配样品中的PHLF的风险。在匹配的队列中进行的进一步分析证实了显着的关联,肝素可降低PHLF的风险(比值比:0.518;95%置信区间:0.295-0.910;P=0.022)。此外,肝素治疗与改善短期术后结局相关,如减少ICU住院时间,对呼吸支持和CRRT的需求减少,低氧血症和ICU死亡率较低。
结论:肝衰竭是肝手术后的重要危险。在ICU护理期间,肝素管理已被证明可以减少肝切除术引起的肝衰竭的发生。这表明肝素可以为控制PHLF提供有希望的选择。
BACKGROUND: Posthepatectomy liver failure (PHLF) is one of the most important causes of death following liver resection. Heparin, an established anticoagulant, can protect liver function through a number of mechanisms, and thus, prevent liver failure.
OBJECTIVE: To look at the safety and efficacy of heparin in preventing hepatic dysfunction after hepatectomy.
METHODS: The data was extracted from Multiparameter Intelligent Monitoring in Intensive Care III (MIMIC-III) v1. 4 pinpointed patients who had undergone hepatectomy for liver cancer, subdividing them into two cohorts: Those who were injected with heparin and those who were not. The statistical evaluations used were unpaired t-tests, Mann-Whitney U tests, chi-square tests, and Fisher\'s exact tests to assess the effect of heparin administration on PHLF, duration of intensive care unit (ICU) stay, need for mechanical ventilation, use of continuous renal replacement therapy (CRRT), incidence of hypoxemia, development of acute kidney injury, and ICU mortality. Logistic regression was utilized to analyze the factors related to PHLF, with propensity score matching (PSM) aiming to balance the preoperative disparities between the two groups.
RESULTS: In this study, 1388 patients who underwent liver cancer hepatectomy were analyzed. PSM yielded 213 matched pairs from the heparin-treated and control groups. Initial univariate analyses indicated that heparin potentially reduces the risk of PHLF in both matched and unmatched samples. Further analysis in the matched cohorts confirmed a significant association, with heparin reducing the risk of PHLF (odds ratio: 0.518; 95% confidence interval: 0.295-0.910; P = 0.022). Additionally, heparin treatment correlated with improved short-term postoperative outcomes such as reduced ICU stay durations, diminished requirements for respiratory support and CRRT, and lower incidences of hypoxemia and ICU mortality.
CONCLUSIONS: Liver failure is an important hazard following hepatic surgery. During ICU care heparin administration has been proved to decrease the occurrence of hepatectomy induced liver failure. This indicates that heparin may provide a hopeful option for controlling PHLF.