低与高的中风体积变化引导和肝切除后术后并发症的减少:一项随机临床试验
Kai-Wei Hsieh1, Wei-Yu Chen2, Yuan-Yi Chia3
1Department of Anesthesiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.
Asian journal of anesthesiology
|January 25, 2024
概括
在肝脏手术中导向输液的中风体积变化 (SVV) 并没有影响术后并发症. 然而,高SVV策略与手术后功能减弱和肝酶升高有关.
科学领域:
- 麻醉学 麻醉学
- 肝胆道手术 肝胆道手术
- 临界护理医学 临界护理医学
背景情况:
- 大型肝脏手术涉及显著的血液动力学变化,使得手术内流体管理至关重要.
- 冲击体积变化 (SVV) 是主要腹部手术中流体响应的验证预测指标.
- 优化液体管理可以改善肝切除患者的术后结果.
研究的目的:
- 为了研究高或低中风体积变化 (SVV) 引导液体输液策略和肝脏手术后的术后并发症之间的关联.
- 为了比较低SVV和高SVV群体之间的感染,多叶膜溢出和乳液脱落的发生率.
- 评估与SVV引导的流体管理相关的术后生理变量和术后疼痛.
主要方法:
- 一项前性随机试验,涉及74名接受肝切除术的患者.
- 患者被分配到低SVV (≤10%) 或高SVV (>10%) 的液体输液策略中.
- 主要结局:术后并发症;次要结局:术后生理变量和疼痛.
主要成果:
- 在低SVV和高SVV组之间没有观察到30天术后并发症的显著差异 (48.6%vs45.9%).
- 高SVV组在手术后显示出明显较低的估计膜过率 (eGFRs).
- 在肝切除后,高SVV组中观察到氨酸转胺酶 (ALT) 水平升高.
结论:
- 无论是低SVV还是高SVV的导向液体输液策略都没有显著影响肝脏主要瘤切除术后并发症的整体率.
- 高SVV策略可能与术后功能受损 (较低的EGFR) 相关.
- 在高SVV组中,术后ALT水平较高表明可能对肝功能产生不良影响.
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