transplantologiyaТрансплантологияTransplantologiya. The Russian Journal of Transplantation2074-05062542-0909IPO Association of Transplantologists10.23873/2074-0506-2025-17-2-126-137transplantologiya-1000Research ArticleАКТУАЛЬНЫЕ ВОПРОСЫ ТРАНСПЛАНТОЛОГИИACTUAL ISSUES OF TRANSPLANTATIONПрогностическая модель вероятности успешной экстубации пациентов в операционной после сочетанной трансплантации почки и поджелудочной железыPrognostic model of the probability of successful extubation in the operating room after simultaneous kidney and pancreas transplantationhttps://orcid.org/0000-0002-0746-1884ХубутияМ. Ш.KhubutiyaM. Sh.

Могели Шалвович Хубутия - акад. РАН, проф., д-р мед. наук, президент ГБУЗ «НИИ скорой помощи им. Н.В. Склифосовского ДЗМ»; заведующий кафедрой трансплантологии и искусственных органов Научно-образовательного института «Высшая школа клинической медицины им. Н.А. Семашко» ФГБОУ ВО «Российский университет медицины» МЗ РФ

129090, Москва, Большая Сухаревская пл., 3

127006, Москва, Долгоруковская ул., д. 4

Mogeli Sh. Khubutiya - Academician of the Russian Academy of Sciences, Prof., Dr. Sci. (Med.), President of N.V. Sklifosovsky Research Institute for Emergency Medicine; Head of the Department of Transplantology and Artificial Organs of the Scientific and Educational Institute "N.A. Semashko Higher School of Clinical Medicine", Russian University of Medicine

3 Bolshaya Sukharevskaya Sq., Moscow 129090

4 Dolgorukovskaya St., Moscow 127006

khubutiyams@sklif.mos.ruhttps://orcid.org/0009-0007-0347-4243ЛебедевМ. В.LebedevM. V.

Максим Владимирович Лебедев - врач анестезиолог-реаниматолог отделения анестезиологии № 3

129090, Москва, Большая Сухаревская пл., 3

Maksim V. Lebedev - Anesthesiologist, Department of Anesthesiology № 3

3 Bolshaya Sukharevskaya Sq., Moscow 129090

lebedevmv@sklif.mos.ruhttps://orcid.org/0000-0002-2824-1020КузнецоваН. К.KuznetsovaN. K.

Наталия Константиновна Кузнецова - канд. мед. наук, ведущий научный сотрудник отделения анестезиологии и реанимации

129090, Москва, Большая Сухаревская пл., 3

Nataliya K. Kuznetsova - Cand. Sci. (Med.), Leading Researcher, Department of Anesthesiology and Resuscitation

3 Bolshaya Sukharevskaya Sq., Moscow 129090

kuznetsovank@sklif.mos.ruhttps://orcid.org/0000-0003-0830-2313ТалызинА. М.TalyzinA. M.

Алексей Михайлович Талызин - канд. мед. наук, заведующий отделением анестезиологии-реанимации № 3

129090, Москва, Большая Сухаревская пл., 3

Aleksei M. Talyzin - Cand. Sci. (Med.), Head of the Department for Anesthesiology and Intensive Care No 3

3 Bolshaya Sukharevskaya Sq., Moscow 129090

talyzinam@sklif.mos.ruhttps://orcid.org/0000-0002-1396-7048БалкаровА. Г.BalkarovA. G.

Аслан Галиевич Балкаров - канд. мед. наук, заведующий научным отделением трансплантации почки и поджелудочной железы ГБУЗ «НИИ скорой помощи им. Н.В. Склифосовского ДЗМ»; доцент кафедры трансплантологии и искусственных органов ФДПО ИНОПР ФГАОУ ВО РНИМУ им. Н.И. Пирогова МЗ РФ (Пироговский университет); заведующий организационно-методическим отделом по трансплантологии ГБУ «НИИ организации здравоохранения и медицинского менеджмента ДЗМ»

129090, Москва, Большая Сухаревская пл., 3

117997, Москва, ул. Островитянова, д. 1

115184, Москва, Большая Татарская ул., д. 30

Aslan G. Balkarov - Cand. Sci. (Med.), Head of the Scientific Department of Kidney and Pancreas Transplantation, N.V. Sklifosovsky Research Institute for Emergency Medicine; Associate Professor of the Department of Transplantology and Artificial Organs, N.I. Pirogov Russian National Research Medical University (Pirogov University); Head of the Organizational and Methodological Department for Transplantology, Research Institute for Healthcare Organization and Medical Management

3 Bolshaya Sukharevskaya Sq., Moscow 129090

1 Ostrovityanov St., Moscow 117997

30 Bolshaya Tatarskaya St., Moscow 115184

balkarovag@sklif.mos.ruhttps://orcid.org/0000-0002-0156-2107ЖуравельН. С.ZhuravelN. S.

Никита Сергеевич Журавель - канд. мед. наук, врач-хирург, старший научный сотрудник отделения трансплантации почки и поджелудочной железы ГБУЗ «НИИ скорой помощи им. Н.В. Склифосовского ДЗМ»; ассистент кафедры трансплантологии и искусственных органов Научно-образовательного института «Высшая школа клинической медицины им. Н.А. Семашко» ФГБОУ ВО «Российский университет медицины» МЗ РФ

129090, Москва, Большая Сухаревская пл., 3

127006, Москва, Долгоруковская ул., д. 4

Nikita S. Zhuravel - Cand. Sci. (Med.), Surgeon, Senior Researcher, Department of Kidney and Pancreas Transplantation, N.V. Sklifosovsky Research Institute for Emergency Medicine; Teaching Assistant of the Department of Transplantology and Artificial Organs of the Scientific and Educational Institute "N.A. Semashko Higher School of Clinical Medicine", Russian University of Medicine

3 Bolshaya Sukharevskaya Sq., Moscow 129090

4 Dolgorukovskaya St., Moscow 127006

zhuravelns@sklif.mos.ruhttps://orcid.org/0000-0002-9992-9260ЖуравельС. В.ZhuravelS. V.

Сергей Владимирович Журавель - доц., д-р мед. наук, заведующий научным отделением анестезиологии и реанимации

129090, Москва, Большая Сухаревская пл., 3

Sergey V. Zhuravel - Assoc. Prof., Dr. Sci. (Med.), Head of the Scientific Department of Anesthesiology and Resuscitation, N.V. Sklifosovsky Research Institute for Emergency Medicine

3 Bolshaya Sukharevskaya Sq., Moscow 129090

zhuravelsv@sklif.mos.ruГБУЗ «НИИ скорой помощи им. Н.В. Склифосовского ДЗМ»; Кафедра трансплантологии и искусственных органов Научно-образовательного института «Высшая школа клинической медицины им. Н.А. Семашко» ФГБОУ ВО «Российский университет медицины» МЗ РФРоссияN.V. Sklifosovsky Research Institute for Emergency Medicine; Department of Transplantology and Artificial Organs of the Scientific and Educational Institute "N.A. Semashko Higher School of Clinical Medicine", Russian University of MedicineRussian FederationГБУЗ «НИИ скорой помощи им. Н.В. Склифосовского ДЗМ»РоссияN.V. Sklifosovsky Research Institute for Emergency MedicineRussian FederationГБУЗ «НИИ скорой помощи им. Н.В. Склифосовского ДЗМ»; Кафедра трансплантологии и искусственных органов ФДПО ИНОПР ФГАОУ ВО РНИМУ им. Н.И. Пирогова МЗ РФ (Пироговский Университет); ГБУ «НИИ организации здравоохранения и медицинского менеджмента ДЗМ»РоссияN.V. Sklifosovsky Research Institute for Emergency Medicine; Department of Transplantation and Artificial Organs, N.I. Pirogov Russian National Research Medical University (Pirogov University); Research Institute for Healthcare Organization and Medical ManagementRussian Federation202504062025172126137Copyright © Хубутия М.Ш., Лебедев М.В., Кузнецова Н.К., Талызин А.М., Балкаров А.Г., Журавель Н.С., Журавель С.В., 20252025Хубутия М.Ш., Лебедев М.В., Кузнецова Н.К., Талызин А.М., Балкаров А.Г., Журавель Н.С., Журавель С.В.Khubutiya M.S., Lebedev M.V., Kuznetsova N.K., Talyzin A.M., Balkarov A.G., Zhuravel N.S., Zhuravel S.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.jtransplantologiya.ru/jour/article/view/1000Введение

Введение. Ранняя экстубация по окончании операции оказывает благоприятное влияние на послеоперационное восстановление пациентов. Длительная и высокотравматичная сочетанная трансплантация почки и поджелудочной железы (СТПиПЖ) у реципиентов с тяжелой исходной патологией и напряженными механизмами гомеостаза не всегда позволяет безопасно выполнить процедуру ранней экстубации. Оценке влияния реципиент-обусловленных факторов и интраоперационных клинических факторов на возможность успешной экстубации в операционной после СТПиПЖ посвящена данная статья.

Цель

Цель. Разработать и обосновать прогностическую модель для определения вероятности успешной экстубации в операционной после СТПиПЖ в зависимости от влияния реципиент-зависимых факторов и интраоперационных клинических факторов.

Материал и методы

Материал и методы. Проведено проспективное исследование с ретроспективным контролем 85 реципиентов, которым в НИИ скорой помощи им. Н.В. Склифосовского выполнили СТПиПЖ в период с 1.01.2008 по 31.12.2024 г. Среди них было 52 мужчины (61%) и 33 женщины (39%), медиана возраста составила 35 (31;39) полных лет. Пациенты были разделены на две группы: в I группу включили пациентов, которые были успешно экстубированы по окончании операции, во II группу – пациентов, неэкстубированных по окончании операции и переведенных в отделение реанимации на продленную искусственную вентиляцию легких (ИВЛ). Были проанализированы длительность нахождения в стационаре, госпитальная и 1-летняя выживаемость реципиентов в обеих группах. С помощью метода бинарной логистической регрессии была разработана прогностическая модель вероятности успешной экстубации пациентов в операционной после СТПиПЖ в зависимости от наличия реципиент-зависимых факторов и интраоперационных клинических факторов с пошаговым исключением по Вальду.

Результаты

Результаты. Прогностическая модель возможности успешной экстубации в операционной является статистически значимой (p<0,001), с чувствительностью и специфичностью модели 76,7% и 73,8%, соответственно. Среди реципиент-зависимых факторов скорректированную статистическую значимость показали индекс массы тела (p=0,003) и длительность заместительной почечной терапии (p=0,037), среди интраоперационных клинических факторов – наличие эпидурального компонента обезболивания в составе общей многокомпонентной анестезии (p<0,001), среднее артериальное давление не ниже 90 мм рт.ст. на реперфузии (p=0,048), фактор длительности операции (p=0,029), суммарное количество фентанила (p<0,001) и цисатракурия (p=0,044).

Заключение

Заключение. Разработанная прогностическая модель позволяет определить тактику интраоперационного ведения пациентов и оптимизировать стратегию анестезиологического обеспечения при СТПиПЖ.

Introduction

Introduction. Early extubation at the end of surgery has a beneficial effect on the postoperative recovery of patients. Prolonged and highly traumatic surgery in recipients with severe initial pathology and tension(al) homeostasis doesn’t allow for safe procedure of early extubation in simultaneous kidney and pancreas transplantation (SKPT). This article aims at assessing the impact of recipient-related factors and intraoperative clinical factors on the possibility of successful extubation in the operating room after SKPT.

Objective

Objective. To develop and substantiate a prognostic model for determining the probability of successful extubation in the operating room after SKPT depending on the impact of recipient-dependent factors and intraoperative clinical factors.

Material and methods

Material and methods. A prospective single-center non-randomized study was conducted, enrolling 85 recipients who underwent SPKT in the N.V. Sklifosovsky Research Institute for Emergency Medicine in the period from 01.01.2008 to 31.11.2024. Among the recipients included in the study, there were 52 men (61%) and 33 women (39%); their median age was 35(31;39) full years. All patients were allocated in two groups. Group I included the patients who were successfully extubated at the end of surgery; group II included the patients non-extubated at the end of surgery who were transferred to the intensive care unit for prolonged mechanical ventilation. Using the binary logistic regression method, a prognostic model was developed for the probability of successful extubation of patients in the operating room after SKPT taking into account the presence of recipient-dependent factors and intraoperative clinical with their step-by-step exclusion according to Wald statistics.

Results

Results. The prognostic model of the possibility of successful extubation in the operating room was found statistically significant (p<0.001), with a sensitivity and specificity of 76.7% and 73.8%, respectively. Among recipient-dependent factors, an adjusted statistical significance was shown by body mass index (p=0.003) and the history of renal replacement therapy duration (p=0.037). Among intraoperative clinical factors, an adjusted statistical significance was shown by the epidural component of anesthesia (p<0.001), mean blood pressure >90 mmHg on reperfusion (p=0.048), the surgery duration factor (p=0.029), a total amount of fentanyl (p<0.001), and a total amount of cisatracurium (p=0.044).

Conclusion

Conclusion. The prognostic model makes it possible to determine the tactics of intraoperative management of patients and optimize the strategy of anesthesiological support in order to ensure possible successful extubation of patients after the SKPT surgery.

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The authors declare that there are no conflicts of interest present.