Department of Anesthesiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.
J Chin Med Assoc. 2012 Dec;75(12):654-9. doi: 10.1016/j.jcma.2012.08.007. Epub 2012 Nov 17.
Low central venous pressure (CVP) produced by fluid restriction has been applied to liver transplant recipients in order to decrease blood loss. However, CVP is not reliable for monitoring intravascular volume and ventricular filling. In addition, doubts remain over the association between fluid restriction and acute kidney injury (AKI). We tested the utility of stroke volume variation (SVV), derived from the FloTrac/Vigileo system, as a decision-making tool in fluid management. We examined the differences in fluid administration, urine output, postoperative AKI, and 30-day and 1-year survival rates between liver transplant recipients with fluid management guided by SVV and CVP.
We retrospectively collected data on our liver transplant recipients with a Model for End-stage Liver Disease score less than 30 and serum creatinine lower than 1.5 mg/dL from 2007 to 2010. Recipients in 2007 and 2008 who received CVP-guided fluid management served as the control group. Recipients in 2009 and 2010 who received fluid administration triggered by SVV were recruited as the study group. The estimated blood loss, urine output, and fluid administered during the operation were recorded. Renal function was assessed using the RIFLE criteria on postoperative days 1 and 5. We also recorded the 30-day and 1-year survival.
Significantly more diuretic use and urine output were noted in the control group in spite of similar fluid administration. However, there was no significant difference in blood loss, AKI, or 30-day and 1-year survival rates.
The outcomes of living donor liver transplant patients who had fluid therapy guided by an SVV less than 10% were similar to those of patients who were given fluids to reach a CVP of 10 mmHg. Our findings suggest that the two measures of vascular filling are similar in liver transplant recipients with demographic characteristics similar to those of our patients.
为了减少出血，肝移植受者采用液体限制使中心静脉压（CVP）降低。然而，CVP 并不能可靠地监测血管内容量和心室充盈。此外，液体限制与急性肾损伤（AKI）之间的关联仍存在疑问。我们测试了来自 FloTrac/Vigileo 系统的每搏变异度（SVV）作为液体管理决策工具的效用。我们比较了以 SVV 指导液体管理与以 CVP 指导液体管理的肝移植受者之间的液体管理、尿量、术后 AKI、30 天和 1 年生存率的差异。
我们回顾性收集了 2007 年至 2010 年 MELD 评分<30 且血清肌酐<1.5 mg/dL 的肝移植受者的数据。2007 年和 2008 年接受 CVP 指导液体管理的受者作为对照组。2009 年和 2010 年接受 SVV 触发的液体管理的受者作为研究组。记录手术期间的估计失血量、尿量和液体管理。术后第 1 天和第 5 天使用 RIFLE 标准评估肾功能。还记录了 30 天和 1 年的生存率。
尽管接受了类似的液体管理，但对照组的利尿剂使用和尿量明显更多。然而，两组的失血量、AKI 或 30 天和 1 年生存率无显著差异。
以 SVV<10%指导液体治疗的活体供肝移植患者的结局与接受液体治疗以达到 CVP 为 10mmHg 的患者相似。我们的发现表明，在我们患者的人口统计学特征相似的肝移植受者中，两种血管充盈测量方法的结果相似。
