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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 ›› 2017, Vol. 06 ›› Issue (04): 275 -279. doi: 10.3877/cma.j.issn.2095-3232.2017.04.009

所属专题： 文献；

临床研究

目标导向液体治疗在肝移植术后液体管理中的应用
王文静1, 郭波2, 吕毅1, 刘昌1, 王博1, 王铮1, 张晓刚1,†()   
  1. 1. 710061　西安交通大学第一附属医院肝胆外科
    2. 710061　西安交通大学医学院遗传学与分子生物学系
  • 收稿日期:2017-03-19 出版日期:2017-08-10
  • 通信作者: 张晓刚
  • 基金资助:
    国家自然科学基金(81670572); 中央高校基本科研业务费专项资金资助(0811/1191320073); 中国博士后科学基金(2016M602801)

Application of goal-directed fluid therapy in fluid management after liver transplantation

Wenjing Wang1, Bo Guo2, Yi Lyu1, Chang Liu1, Bo Wang1, Zheng Wang1, Xiaogang Zhang1,†()   

  1. 1. Department of Hepatobiliary Surgery, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, China
    2. Department of Genetics and Molecular Biology, Xi'an Jiaotong University College of Medicine, Xi'an 710061, China
  • Received:2017-03-19 Published:2017-08-10
  • Corresponding author: Xiaogang Zhang
  • About author:
    Corresponding author:Zhang Xiaogang, Email:
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目的

探讨目标导向液体治疗（GDT）在肝移植患者术后液体管理中应用的安全性和有效性。

方法

本前瞻性研究对象为2015年1月至2016年7月在西安交通大学第一附属医院行原位肝移植术的109例患者。根据术后处理措施不同将患者分为GDT组和对照组。其中GDT组51例，男38例，女13例；平均年龄（45±18）岁；采用GDT方案。对照组58例，男43例，女15例；年龄（47±17）岁；采用常规肝移植术后处理措施。患者均签署知情同意书，符合医学伦理学规定。两组首次排气时间、排便时间及术后ICU住院时间比较采用t检验；并发症发生率比较采用χ2检验。

结果

原位肝移植术后，GDT组术后首次排气时间、排便时间、ICU住院时间分别为（2.1±0.4）、（3.1±1.3）、（3.5±0.9） d，明显短于对照组的（3.2±2.1）、（4.9±1.8）、（5.4±1.3） d（t=-3.681，-5.912，-8.753；P<0.05）。GDT组术后容量相关并发症发生率为10%（5/51），明显低于对照组的26%（15/58）（χ2=4.671，P<0.05）。

结论

GDT在肝移植术后液体管理中是安全、有效的，可加速患者术后康复。

关键词: 肝移植, 加速康复外科, 目标导向液体治疗, 液体管理
Objective

To investigate the safety and effectiveness of application of goal-directed fluid therapy (GDT) in the fluid management after liver transplantation (LT).

Methods

One hundred and nine patients who underwent orthotopic LT in the First Affiliated Hospital of Xi'an Jiaotong University between January 2015 and July 2016 were enrolled in this prospective study. According to the postoperative manage measures, the patients were divided into the GDT group (n=51) and control group (n=58). In the GDT group, 38 cases were males and 13 were females, aged (45±18) years old on average, and GDT was used in the patients. In the control group, 43 cases were males and 15 were females, aged (47±17) years old on average, and conventional postoperative manage measures were used in the patients. The informed consents of all patients were obtained and the local ethical committee approval was received. The first exhaust time, defecation time and postoperative length of ICU stay in two groups were compared using t test. The incidence of complications was compared using Chi-square test.

Results

The first exhaust time, defecation time and length of ICU stay after orthotopic LT in the GDT group was respectively (2.1±0.4), (3.1±1.3), (3.5±0.9) d, significantly shorter than (3.2±2.1), (4.9±1.8) and (5.4±1.3) d in the control group (t=-3.681, -5.912, -8.753; P<0.05). The incidence of postoperative volume-related complications in the GDT group was 10%(5/51), significantly lower than 26%(15/58) in the control group (χ2=4.671, P<0.05).

Conclusions

GDT is a safe and efficacious approach for fluid management after LT, and it can accelerate the postoperative recovery of the patients.

Key words: Liver transplantation, Enhanced recovery after surgery, Goal directed therapy, Fluid management
表1 GDT组与对照组术后处理措施比较
措施 GDT组 对照组
中心静脉压 5～8 mmHg[1] 未监测
平均动脉压 >65 mmHg 未监测
肝后下腔静脉内径 1.0～1.5 cm 未监测
血流灌注指数 >1.4 未监测
心输出量 4～6 L/min 未监测
中心静脉血氧饱和度 60%～80% 未监测
乳酸 <1 mmol/L 未监测
Hb 90 g/L 100～110 g/L
ALB 30～35 g/L >35 g/L
PT 16～18 s 14～16 s
肠内营养 麻醉清醒，生命体征平稳可饮水，并逐步增加 通气排便后
液体入量 1 000～1 500 ml/d，进食后逐步减量 1 500～2 500 ml/d
出入液体平衡 负平衡 未要求
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