分析多模式保温在肝移植围手术期的应用效果以及对术后早期并发症的影响。

选取南京大学医学院附属金陵医院2019年9月1日至2025年1月31日期间接受肝移植的受者为观察对象，以多模式保温技术执行时间为分界点，分为常规保温组和多模式保温组，通过1 ∶1倾向性评分匹配程序共匹配到150对受者。收集两组受者围手术期低体温发生情况、低体温累积时间和面积，以及术后气管导管拔除时间、早期移植物功能障碍、感染、急性肾损伤等并发症情况。符合正态分布的计量资料以均数±标准差(±s)表示，组间比较采用两独立样本t检验；非正态分布的计量资料以中位数(上下四分位数)[M(P₂₅，P₇₅)]表示，组间比较采用Mann-Whitney U检验。计数资料以例(%)表示，组间比较采用χ²检验。P<0.05为差异有统计学意义。

多模式保温组低体温发生率为42.7%(64/150)，低体温累积时间为(22.3±8.4) min，低体温累积面积为(4.5±2.3) ℃·min，均低于常规保温组[65.3%(98/150)，(29.6±10.0) min, (5.8±2.7 )℃·min](χ²＝15.152，t＝6.844和4.771，P均<0.05)。多模式保温组阻断肝门时和下腔静脉再开放5 min时体温分别为(36.2±0.3)和(35.6±0.6)℃，均高于常规保温组[(36.1±0.3)和(35.2±0.6)℃，t＝－2.459和－4.955，P均<0.05]。多模式保温组和常规保温组术中出血量分别为1 600(1 250，2 190)和1 870(1 300，2 600)mL，输注血浆量分别为900(700，1 300)和1 000(800，1 600)mL，差异均有统计学意义(Z＝－2.508和－2.303，P均<0.05)。多模式保温组再灌注综合征发生率为22.7%(34/150)，低于常规保温组(35.3%，53/150)(χ²＝5.844，P<0.05)。多模式保温组术后气管导管拔除时间为3(2，9) h，短于常规保温组7(3，13) h (Z＝－4.110，P<0.05)。

多模式保温可改善肝移植术中低体温发生率和持续时间，降低受者术中出血量及对血制品的需求，术后并发症发生率更低，术后气管导管拔除时间更短，可促进受者快速康复。

To analyze the application effect of multimodal warming in the perioperative period of liver transplantation and its impact on early postoperative complications.

Patients who underwent liver transplantation at Affiliated Jinling Hospital, Medical School of Nanjing University from September 1, 2019 to January 31, 2025 were selected as observation subjects. They were divided into the conventional warming group and the multimodal warming group, using the implementation time of multimodal insulation regulations as the demarcation point. A total of 150 pairs of recipients were matched using a 1 ∶1 propensity score matching method. Perioperative temperature data and prognosis-related data of liver transplant recipients were collected, and the duration of intraoperative hypothermia, severity of hypothermia, and postoperative complications between the two groups were compared. Normally distributed measurement data were expressed as mean±standard deviation (±s), and comparisons between groups were performed using independent-samples t-test. Non-normally distributed measurement data were presented as median (interquartile range) [M(P₂₅, P₇₅)], and Mann-Whitney U test was used for inter-group comparison. Count data were expressed as number (percentage), and comparisons between groups were conducted using the χ² test or Fisher′s exact probability test. A P value <0.05 was considered statistically significant.

The incidence of hypothermia in the multimodal warming group was 42.7% (64/150), with a cumulative time of (22.3±8.4) min and a cumulative area of (4.5±2.3) ℃·min, all of which were lower than those in the conventional warming group [65.3% (98/150), (29.6±10.0) min, (5.8 ± 2.7) ℃·min] (χ²=15.152, t=6.844 and 4.771, all P<0.05). The body temperature of the multimodal warming group during hepatic portal occlusion was (36.2±0.3) ℃, and (35.6±0.6) ℃ at 5 min after inferior vena cava recanalization, both higher than those in the conventional warming group [(36.1±0.3) ℃ and (35.2±0.6) ℃, t=-2.459 and -4.955, all P<0.05]. The multimodal warming group also showed significantly lower intraoperative bleeding [1 600 (1 250, 2 190) vs 1 870 (1 300, 2 600) mL, Z=-2.508, P< 0.05], plasma transfusion [900 (700, 1 300) vs 1 000 (800, 1 600) mL, Z=-2.303, P<0.05], incidence of reperfusion syndrome [22.7% vs 35.3%, χ²=5.844, P<0.05], and a shorter postoperative time to extubation of tracheal tube [3(2, 9) vs 7(3, 13) h, Z=-4.110, P<0.05].

Multimodal warming technology can reduce the incidence and duration of intraoperative hypothermia in liver transplantation, decrease intraoperative bleeding and blood product requirements, lower the incidence of postoperative complications, and shorten the time of postoperative extubation, which promotes the rapid recovery of liver transplant recipients.