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

doi:10.3877/cma.j.issn.2095-3232.2017.04.009

Abstract

Abstract:

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

Wenjing Wang, Bo Guo, Yi Lyu, Chang Liu, Bo Wang, Zheng Wang, Xiaogang Zhang. Application of goal-directed fluid therapy in fluid management after liver transplantation[J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2017, 06(04): 275-279.

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References 19

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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

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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