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中华肝脏外科手术学电子杂志

中华肝脏外科手术学电子杂志 ›› 2026, Vol. 15 ›› Issue (03) : 398 -404. doi: 10.3877/cma.j.issn.2095-3232.2026.03.015

临床研究

早期拔除气管插管快通道麻醉在肝移植中应用
杨健良1, 张爱玲2, 王晓明1, 代天星1, 袁峰1, 朱灿华1, 蓝岚2, 杨汉宇2, 汪国营1,†()   
  1. 1　510120　广州医科大学附属第一医院肝胆外科
    2　510120　广州医科大学附属第一医院麻醉科
  • 收稿日期:2025-10-22 出版日期:2026-06-10
  • 通信作者: 汪国营
  • 基金资助:
    广东省自然科学基金(2022A1515010519); 广州市基础研究计划市院联合资助项目(202524)

Clinical application of fast-track anesthesia with early tracheal extubation after liver transplantation

Jianliang Yang1, Ailing Zhang2, Xiaoming Wang1, Tianxing Dai1, Feng Yuan1, Canhua Zhu1, Lan Lan2, Hanyu Yang2, Guoying Wang1,†()   

  1. 1 Department of Hepatobiliary Surgery, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China
    2 Department of Anesthesiology, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China
  • Received:2025-10-22 Published:2026-06-10
  • Corresponding author: Guoying Wang
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杨健良, 张爱玲, 王晓明, 代天星, 袁峰, 朱灿华, 蓝岚, 杨汉宇, 汪国营. 早期拔除气管插管快通道麻醉在肝移植中应用[J/OL]. 中华肝脏外科手术学电子杂志, 2026, 15(03): 398-404.

Jianliang Yang, Ailing Zhang, Xiaoming Wang, Tianxing Dai, Feng Yuan, Canhua Zhu, Lan Lan, Hanyu Yang, Guoying Wang. Clinical application of fast-track anesthesia with early tracheal extubation after liver transplantation[J/OL]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2026, 15(03): 398-404.

目的

探讨早期拔除气管插管的快通道麻醉在同种异体肝移植中的可行性。

方法

回顾性分析2024年1月至2025年1月在广州医科大学附属第一医院接受肝移植术后早期拔除气管插管的8例患者临床资料。患者均签署知情同意书，符合医学伦理学规定。其中男7例，女1例；年龄34~62岁，中位年龄48岁，观察患者术中、术后情况，ICU时间和术后住院时间。

结果

8例患者均顺利完成手术，术后早期拔除气管插管。手术时间347(255~510) min，无肝期50（38~79） min，术中出血量400（50~800） ml，术后气管插管拔除时间45（20~70）min，无ICU二次插管，无术后肺部感染，无围手术期死亡。术后1周内肝功能ALT、TB呈下降趋势，术后3 d血气pH基本维持在正常值范围内，未发生严重酸碱平衡紊乱。ICU住院时间2（0~5）d，术后住院时间21（12~41）d。

结论

选择适宜病例，肝移植术后早期拔除气管插管是安全可行的，快通道麻醉对肝移植术后康复具有积极的促进作用。

关键词: 早期拔除气管插管, 加速康复外科, 快通道麻醉, 肝移植术
Objective

To evaluate the feasibility of fast-track anesthesia with early tracheal extubation in orthotopic liver transplantation.

Methods

Clinical data of 8 patients who underwent liver transplantation in the First Affiliated Hospital of Guangzhou Medical University from January 2024 to January 2025 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 7 patients were male and 1 female, aged from 34 to 62 years, with a median age of 48 years. Intraoperative and postoperative conditions were observed. The length of ICU and postoperative hospital stay were recorded.

Results

All 8 patients successfully completed the surgery. Early tracheal extubation was performed. The operation time was 347 (255-510) min, the anhepatic phase was 50 (38-79) min, intraoperative blood loss was 400 (50-800) ml, and the time of tracheal extubation was 45 (20-70) min after surgery. No second intubation in ICU stay, postoperative pulmonary infection or perioperative death occurred. ALT and TB levels tended to decline within postoperative 1 week. Blood gas and pH were basically maintained within the normal range within postoperative 3 d. No serious acid-base balance disorder occurred. The length of ICU stay was 2 (0-5) d. The length of postoperative hospital stay was 21 (12-41) d.

Conclusions

For eligible cases, it is safe and feasible to perform early tracheal extubation after liver transplantation. Fast-track anesthesia exerts a positive effect on rehabilitation after liver transplantation.

Key words: Early tracheal extubation, Enhanced recovery after surgery(ERAS), Fast-track anesthesia, Liver transplantation
表1 八例肝移植术后早期拔除气管插管患者术前临床资料
例序 性别 年龄 诊断 合并症 Child-Pugh评分 MELD评分 ECOG-PS评分
1 男 43 肝恶性肿瘤(肝癌综合治疗后) 2型糖尿病 5 2 0
2 男 39 肝恶性肿瘤(肝癌综合治疗后) 无 5 6 0
3 男 34 肝恶性肿瘤(肝癌综合治疗后) 无 9 11 0
4 男 62 肝恶性肿瘤(肝癌综合治疗后) 2型糖尿病 6 3 1
5 男 52 肝硬化脾切除术后+门静脉血栓 无 7 5 1
6 男 46 肝恶性肿瘤(肝癌综合治疗后) 无 6 5 0
7 男 51 肝恶性肿瘤(左肝癌切除术后) 2型糖尿病 5 7 0
8 女 50 肝恶性肿瘤(肝癌综合治疗后) 无 7 5 1
表2 八例肝移植术后早期拔除气管插管患者围手术期临床资料
例序 手术时间(min) 无肝期（min) 术中出血量(ml) 术中输血量 ICU住院时间(d) 术后住院时间(d) 出院后30 d再入院
1 298 38 200 血浆400 ml 2 14 无
2 255 42 50 血浆400 ml 1 12 无
3 380 65 600 红细胞6 U, 血浆600 ml 0 24 无
4 315 39 600 红细胞6 U, 血浆550 ml 1 17 无
5 270 38 200 血浆1 100 ml 1 15 无
6 415 58 500 红细胞4 U, 血浆900 ml 5 20 无
7 510 79 800 红细胞13 U, 血浆400 ml 2 41 有
8 340 45 500 红细胞6.5 U, 血浆400 ml 3 29 无
表3 八例肝移植术后早期拔除气管插管患者围手术期恢复情况
例序 ALT(U/L) TB(μmol/L) 血气pH
1 d 3 d 7 d 1 d 3 d 7 d 1 d 3 d 7 d
1 167 147 62 24.5 23.1 20.5 7.24 7.35 7.38
2 324 280 120 44.8 37.1 21 7.35 7.39 7.34
3 601 539 47 131.9 112.4 36.3 7.34 7.44 7.41
4 130 73 21 15.2 11.8 9.7 7.41 7.44 7.46
5 438 234 162 51.9 42.2 39.7 7.39 7.38 7.46
6 187 180 93 33 33.1 26 7.29 7.37 7.4
7 597 416 137 98.5 59.4 44.3 7.36 7.36 7.41
8 1 376 679 278 110.6 41.4 26.5 7.41 7.41 7.43
表4 八例肝移植患者早期拔除气管插管安全性
例序 术毕至拔除气管插管时间(min) 拔管后去向 ICU二次气管插管 术后无创呼吸机支持 术后肺部感染
1 61 ICU 无 有 无
2 60 ICU 无 有 无
3 40 普通病房 无 无 无
4 45 ICU 无 无 无
5 35 ICU 无 有 无
6 36 ICU 无 有 无
7 20 ICU 无 有 无
8 70 ICU 无 无 无
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