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Effect of perioperative fluid therapy on early phase prognosis after liver transplantation

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Hepatobiliary & Pancreatic Diseases International 2008年第4期7卷 367-372页

作者： Jiang, Guo-Qing Peng, Min-Hao Yang, Ding-Hua Guangxi Med Univ Affiliated Hosp 1 Dept Hepatobiliary Surg Nanning 530021 Peoples R China Peoples Hosp Subei Dept Hepatobiliary Surg Yangzhou 225001 Peoples R China

BACKGROUND: Although liver transplantation (LT) has made rapid progress, early pulmonary complications still occur. More attention should be paid to fluid therapy that may be an important factor leading to these complications. It is necessary to investigate the correlation between intraoperative and postoperative fluid therapy and early pulmonary complications after LT, then attempt to provide a reasonable fluid therapy in the perioperative period. METHODS: Sixty-two patients who had undergone Ff were enrolled and analyzed retrospectively. Based on early phase prognosis after LT, the 62 patients were divided into a non-pulmonary complication group and a pulmonary complication group. Twenty perioperative variables were analyzed in both groups to screen out several factors causing early pulmonary complications, then the parameters reflecting postoperative recovery were analyzed. RESULTS: The pulmonary complication group had 29 patients (46.77%), 3 (4.84%) of whom died during the perioperative period. Using monofactorial analysis for each variable, the two groups differed in the following variables: preoperative lung function, volume of intraoperative transfusion, volume of intraoperative bleeding, and volume of intraoperative net fluid retention and fluid balance (= 2 of the first 3 days after operation. Analysis of the relationship between multivariate factors and pulmonary complications after LT by logistic multivariate regression analysis showed that preoperative lung function, volume of intraoperative bleeding, and fluid balance (=-2 of the first 3 days after operation were influential factors. CONCLUSIONS: It is important to maintain fluid balance during the perioperative period of LT. If the hemodynamics are stable, appropriate negative fluid balance in the first 3 days after operation apparently decreases the incidence of early pulmonary complications after LT. These measures are associated with better postoperative recovery.

关键词： liver transplantation perioperative period fluid therapy fluid balance

Goal-directed fluid therapy May Improve Hemodynamic Stability of Parturient with Hypertensive Disorders of Pregnancy Under Combined Spinal Epidural Anesthesia for Cesarean Delivery and the Well-being of Newborns

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Chinese Medical Journal 2015年第14期128卷 1922-1931页

作者： Wei Xiao Qing-Fang Duan Wen-Ya Fu Xin-Zuo Chi Feng-Ying Wang Da-Qing Ma Tian-Long Wang Lei Zhao Department of Anesthesiology Xuan Wu Hospital Capital Medical University Beijing 100053 China Department of Obstetrics and Gynecology Xuan Wu Hospital Capital Medical University Beijing 100053 China Department of Surgery and Cancer Pain Medicine and Intensive Care Faculty of Medicine Chelsea and Westminster Hospital Imperial College London United Kingdom

Background： Hypotension induced by combined spinal epidural anesthesia in parturient with hypertensive disorders of pregnancy （HDP） can easily compromise blood supply to vital organs including uteroplacental perfusion and result in fetal distress. The aim of this study was to investigate whether the goal-directed fluid therapy （GDFT） with LiDCOrapid system can improve well-being of both HDP parturient and their babies. Methods： Fifty-two stable HDP parturient scheduled for elective cesarean delivery were recruited. After loading with 10 ml/kg lactated Ringer＇s solution （LR）, parturient were randomized to the GDFT and control group. In the GDFT group, individualized fluid therapy was guided by increase in stroke volume （ASV） provided via LiDCO rapid system. The control group received the routine fluid therapy. The primary endpoints included maternal hypotension and the doses of vasopressors administered prior to fetal delivery. The secondary endpoints included umbilical blood gas abnormalities and neonatal adverse events. Results： The severity of HDP was similar between two groups. The total LR infusion （P 〈 0.01） and urine output （P 〈 0.05） were higher in the GDFT group than in the control group. Following twice fluid challenge tests, the systolic blood pressure, mean blood pressure, cardiac output and SV in the GDFT group were significantly higher, and the heart rate was lower than in the control group. The incidence of maternal hypotension and doses of phenylephrine used prior to fetal delivery were significantly higher in the control group than in the GDFT group （P 〈 0.01）. There were no differences in the Apgar scores between two groups. In the control group, the mean values of pH in umbilical artery/vein were remarkably decreased （P 〈 0.05）, and the incidences of neonatal hypercapnia and hypoxemia were statistically increased （P 〈 0.05） than in the GDFT group. Conclusions： Dynamic responsiveness guided fluid therapy with the LiDCOrapid system may provide po

关键词： Cesarean Delivery fluid therapy Hypertensive Disorders of Pregnancy LiDCOrapid System Parturient

Bioreactance-guided fluid therapy for excision of a giant brain tumor in an infant under general anesthesia:A case report and literature review

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Brain Science Advances 2021年第3期7卷 199-206页

作者： Yao Chen Ting Fan Tsinghua University Yuquan Hospital Beijing 100040China

Pediatric patients are more likely to suffer from brain *** resection is often the optimal *** management of pediatric brain tumor resection brings great challenges to anesthesiologists,especially for fluid *** this case,the infant-patient was only 69-day-old,weighed 6 kg,but she was facing a gaint brain tumor(7.9 cm×8.1 cm×6.7 cm)*** infant was at great risks such as hemorrhagic shock,cerebral edema,pulmonary edema,congestive heart failure,coagulation dysfunction,***,we tried to use the parameters obtained by bioreactance-based NICOM^(■)device(Cheetah Medical)to guide the infant’s intraoperative fluid therapy,and successfully avoided these complications and achieved a good prognosis.

关键词： fluid therapy bioreactance technology brain tumor excision infant

A retrospective study of fluid therapy for 100 patients of liver transplantation

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Journal of Medical Colleges of PLA(China) 2006年第1期21卷 60-65页

作者：石学银徐振东徐海涛刘刚蒋京京张燏 Department of AnesthesiologyChangzheng Hospital Second Military Medical UniversityShanghai 200003China

Objective： To review the evolution of fluid therapy （IOFT） during liver transplantation （LTX） based on clinical experience in our institute over 7 years. Methods： All patient records （n= 130） of LTX from 1996 to 2003 were examined. After excluding patients with co-morbidities 100 cases were found suitable for IOFT analysis. All patients had undergone LTX and follow-up under the same surgical team. Based on IOFT records we tried to identify distinct patterns of practice evolving over 7 years. Intraoperarive hemodynamics （IOHD） and long-term outcome records were examined. Results： Retrospectively, 3 types of IOFT were found. Group A （n= 18, period 1996-1997） received high amounts of crystallolds; group B （n=24, period 1998-2000） received high amounts of plasma and albumin; and group C （n=58, period 2001-2003） received lower amounts of albumin and plasma and recommended amounts of 6% hydroxyethyl starch 200/0. 5 （HES） and high amounts of vasopressors, lntraoperatively, group A exhibited the highest levels of central venous and pulmonary artery pressures in the neo-hepatic stage （P〈0.05）. Postoperatively, the patients in group C had the shortest time to extubation ; the values for group A,B,C were （15.8±11）, （17.3±10.2） and （7.98±3.2） h respectively（P〈0.05）. At the end of one-year follow-up, the patients in group C had the lowest mortality （group A, B, C were 27. 78%, 29. 17% and 6.25% respectively; P〈0. 05）. Conclusion： In our institute over the years the use of crystalloids, albumin and plasma during IOFT of LTX is gradually replaced to a large extent by HES. The improvements in IOHD and long term outcomes are likely to be related to improved surgical experience of our team. Nevertheless, the shift in IOFT practices might be associated with an beneficial effect on IOHD or long term outcome. Treatment with proper amount of liquid and vasoactive drugs may be a better method of fluid thera- py.

关键词： liver transplant fluid therapy hemodynamics mortality

Perioperative fluid management in major hepatic resection: an integrative review

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Hepatobiliary & Pancreatic Diseases International 2017年第5期16卷 458-469页

作者： Osamu Yoshino Marcos Vinicius Perini Christopher Christophi Laurence Weinberg Department of Surgery Austin Hospital and University of Melbourne Melbourne Victoria Australia Anaesthesia Perioperative Pain Medicine Unit University of Melbourne Melbourne Victoria Australia

BACKGROUND: fluid intervention and vasoactive pharmacological support during hepatic resection depend on the preference of the attending clinician, institutional resources, and practice culture. Evidence-based recommendations to guide perioperative fluid management are currently limited. Therefore, we provide a contemporary clinical integrative overview of the fundamental principles underpinning fluid intervention and hemodynamic optimization for adult patients undergoing major hepatic resection. DATA SOURCES: A literature review was performed of MEDLINE, EMBASE and the Cochrane Central Registry of Controlled Trials using the terms 'surgery', 'anesthesia', 'starch', 'hydroxyethyl starch derivatives', 'albumin', 'gelatin', 'liver resection', 'hepatic resection', 'fluids', 'fluid therapy', 'crystalloid', 'colloid', 'saline', 'plasma-Lyte', 'plasmalyte', 'hartmann's', 'acetate', and 'lactate'. Search results for MEDLINE and EMBASE were additionally limited to studies on human populations that included adult age groups and publications in English. RESULTS: A total of 113 articles were included after appropriate inclusion criteria screening. Perioperative fluid management as it relates to various anesthetic and surgical techniques is ***: Clinicians should have a fundamental understanding of the surgical phases of the resection, hemodynamic goals, and anesthesia challenges in attempts to individualize therapy to the patient's underlying pathophysiological condition. Therefore, an ideal approach for perioperative fluid therapy is always individualized. Planning and designing large-scale clinical trials are imperative to define the optimal type and amount of fluid for patients undergoing major hepatic resection. Further clinical trials evaluating different intraoperative goal-directed strategies are also eagerly awaited.

关键词： hepatic resection liver resection fluid therapy anesthesia crystalloid colloid goal-directed therapy

Carbachol promotes gastrointestinal function during oral resuscitation of burn shock

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World Journal of Gastroenterology 2011年第13期17卷 1746-1752页

作者： Sen Hu Jin-Wei Che Yi-jun Tian Zhi-Yong Sheng Research Laboratory of Shock and Multiple Organ Dysfunction Burns Institute First Hospital Affiliated to the PLA GeneralHospital Beijing 100048 China

AIM: To investigate the effect of carbachol on gastrointestinal function in a dog model of oral resuscitation for burn shock. METHODS: Twenty Beagle dogs with intubation of the carotid artery, jugular vein and jejunum for 24 h were subjected to 35% total body surface area fullthickness burns, and were divided into three groups: no fluid resuscitation (NR, n = 10), in which animals did not receive fluid by any means in the first 24 h postburn; oral fluid resuscitation (OR, n = 8), in which dogs were gavaged with glucose-electrolyte solution (GES) with volume and rate consistent with the Parkland formula; and oral fluid with carbachol group (OR/CAR, n = 8), in which dogs were gavaged with GES containing carbachol (20 μg/kg), with the same volume and rate as the OR group. Twenty-four hours after burns, all animals were given intravenous fluid replacement, and 72 h after injury, they received nutritional support. Hemodynamicand gastrointestinal parameters were measured serially with animals in conscious and cooperative state. RESULTS: The mean arterial pressure, cardiac output and plasma volume dropped markedly, and gastrointestinal tissue perfusion was reduced obviously after the burn injury in all the three groups. Hemodynamic parameters and gastrointestinal tissue perfusion in the OR and OR/CAR groups were promoted to pre-injury level at 48 and 72 h, respectively, while hemodynamic parameters in the NR group did not return to pre-injury level till 72 h, and gastrointestinal tissue perfusion remained lower than pre-injury level until 120 h post-burn. CO 2 of the gastric mucosa and intestinal mucosa blood flow of OR/CAR groups were 56.4 ± 4.7 mmHg and 157.7 ± 17.7 blood perfusion units (BPU) at 24 h postburn, respectively, which were significantly superior to those in the OR group (65.8 ± 5.8 mmHg and 127.7 ± 11.9 BPU, respectively, all P < 0.05). Gastric emptying and intestinal absorption rates of GES were significantly reduced to the lowest level (52.8% and 23.7% of

关键词： Burn shock fluid therapy Oral rehydration Carbachol Animal model Gastric emptying Intestinal absorption

Perioperative"remote"acute lung injury:recent update

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The Journal of Biomedical Research 2017年第3期31卷 197-212页

作者： Zhaosheng Jin Ka Chun Suen Daqing Ma Anaesthetics Pain Medicine and intensive CareDepartment of Surgery and CancerFaculty of MedicineImperial College LondonChelsea&Westminster HospitalLondon SW10 9NHUK

Perioperative acute lung injury（ALI） is a syndrome characterised by hypoxia and chest radiograph *** is a serious post-operative complication,associated with considerable mortality and *** addition to mechanical ventilation,remote organ insult could also trigger systemic responses which induce ***,there are limited treatment options available beyond conservative respiratory ***,increasing understanding of the pathophysiology of ALI and the biochemical pathways involved will aid the development of novel treatments and help to improve patient outcome as well as to reduce cost to the health *** this review we will discuss the epidemiology of peri-operative ALI;the cellular and molecular mechanisms involved on the pathological process;the clinical considerations in preventing and managing perioperative ALI and the potential future treatment options.

关键词： acute lung injury intraoperative care/adverse effects postoperative complications inflammation,anesthetics general fluid therapy

Spontaneous diuresis and negative fluid balance predicting recovery and survival in patients with trauma-hemorragic shock

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Chinese Journal of Traumatology 2003年第6期6卷 382-384页

作者：缑东元朱雅芳金燕陈丽英 ICU Affiliated Sir Run Run Shaw Hospital Zhejiang University

Most patients with trauma-hemorragic shock, prior to ICU admission, have been resuscitated and stabilized in the emergency room (ER) and/or operation room (OR). Many of them suffer from systemic edema. This extra-vascular fluid is caused by massive infusion of fluid and blood for the maintenance of blood pressure. During the recovery stage, the patients exhibit spontaneous diuresis followed by negative fluid balance. Urine volumes of some patients are more than 10000 ml/d. Do we need to maintain a balance between daily input and output of water at this situation? There are many references in the medical literature and textbooks about fluid resuscitation and the principles in maintaining the balance between input and output of water, but rarely about when and how to restrict it, that is, when and how to permit a negative balance. In this retrospective review, we examined the resuscitation records of 205 patients with systemic edema after trauma-hemorragic shock.

关键词： Cause of Death Water-Electrolyte Balance Adolescent Adult Aged Aged, 80 and over Child Critical Care Diuresis Female fluid therapy Humans Injury Severity Score Intensive Care Units Male Middle Aged Multiple Trauma Predictive Value of Tests Probability Prognosis Retrospective Studies Risk Assessment Shock, Hemorrhagic Survival Rate

fluids administration and coagulation characteristics in patients with different model for end-stage liver disease scores undergoing orthotopic liver transplantation

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Chinese Medical Journal 2007年第22期120卷 1963-1968页

作者： LI Min ZHANG Li-ping YANG Lu Department of Anesthesiology Peking University Third Hospital Beijing 100083 China

Background There have been many studies investigating the impact of the model for end-stage liver disease （MELD） score on predicting post-transplant outcome. But it is unclear whether MELD is correlated to intraoperative fluid therapy and coagulation status. We investigated the relationship between the severity of liver diseases as measured by MELD score and intraoperative fluid requirements and the changes of coagulation characteristics. Methods Ninety patients were included in this retrospective study. The patients were stratified into three groups according to the MELD scores：〈15 （low）, 15-25 （medium） and 〉25 （high）. Intraoperatively, volume was restored with allogeneic and/or salvaged red blood cells （RBC）, fresh-frozen plasma （FFP）, platelet and other types of fluids according to hemodynamic data, hematocrit, and clotting data. Intraoperative coagulation data, blood requirements and other fluids administered were compared among the 3 groups. Results Before surgery, in addition to the three variables used to calculate MELD scores in other baseline laboratory values, including ratio of activated partial thromboplastin time （R-APTT）, D-Dimer, hematocrit, platelet and blood urea nitrogen （BUN） were significantly different among the 3 groups. The blood loss increased with increasing MELD. The volume of RBC （allogeneinc, salvaged and total）, FFP, platelet and the total volume of transfusion were also significantly different among the three groups （P〈0.01）. The requirements for prothrombin complex and fibrinogen showed a similar pattern. During operation, the changing trends of each coagulation variable were different. Compared with baseline, during each intraoperative stage, INR and R-APPT increased in the low MELD group. While in the medium MELD and high MELD groups, INR did not changed significantly during the operation, and R-APPT significantly increased only after reperfusion. Conclusions This study provided some useful information for perioperative manage

关键词： liver transplantation fluid therapy coagulation, blood