Seo Hyungseok, Jun In-Gu, Ha Tae-Yong, Hwang Shin, Lee Sung-Gyu, Kim Young-Kug
From the Department of Anesthesiology and Pain Medicine, Seoul National University Hospital (HS); Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine (I-GJ, Y-KK); and Division of Liver Transplantation and Hepatobiliary Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea (T-YH, SH, S-GL).
Medicine (Baltimore). 2016 Jan;95(2):e2328. doi: 10.1097/MD.0000000000002328.
Optimal fluid management to reduce blood loss during donor hepatectomy is important for maximizing donor safety. Mannitol can induce osmotic diuresis, helping prevent increased intravascular volume status. We therefore evaluated the effect of high stroke volume variation (SVV) method by mannitol administration and fluid restriction on blood loss during donor hepatectomy.In this prospective study, 64 donors scheduled for donor right hepatectomy were included and allocated into 2 groups. In group A, the SVV value of each patient was maintained at 10% to 20% during hepatic resection with 0.5 g/kg mannitol administration and fluid restriction at a rate of 2 to 4 mL/kg/h. In group B, the SVV value was maintained at <10% by fluid administration at a rate of 6 to 10 mL/kg/h without diuretic administration during surgery. Intraoperative blood loss was estimated by the loss of red cell mass. Surgeon satisfaction scores and postoperative outcomes, including acute kidney injury, abnormal chest radiographic findings, and hospital stay duration, were also assessed.SVV during hepatectomy was significantly higher in group A than in group B (11.0 ± 1.7 vs 6.5 ± 1.1, P < 0.001). The red cell mass loss was significantly lower in group A than in group B (145.4 ± 107.6 vs 307.9 ± 110.7 mL, P < 0.001). Surgeon satisfaction scores were higher in group A than in group B (2.8 ± 0.5 vs 2.0 ± 0.6, P < 0.001). The incidence of acute kidney injury, abnormal chest radiographic findings, and duration of hospital stay did not significantly differ between the 2 groups.Maintenance of high SVV by mannitol administration is effective and safe for reducing blood loss during donor hepatectomy.
优化液体管理以减少供体肝切除术期间的失血对于最大限度提高供体安全性至关重要。甘露醇可诱导渗透性利尿，有助于防止血管内容量增加。因此，我们评估了通过甘露醇给药和液体限制的高每搏量变异（SVV）方法对供体肝切除术期间失血的影响。
在这项前瞻性研究中，纳入了64例计划进行右半肝供体切除术的供体，并将其分为2组。A组在肝切除术中通过给予0.5 g/kg甘露醇并以2至4 mL/kg/h的速度限制液体摄入，将每位患者的SVV值维持在10%至20%。B组在手术期间通过以6至10 mL/kg/h的速度给予液体维持SVV值<10%，不给予利尿剂。术中失血通过红细胞量的损失来估计。还评估了外科医生满意度评分和术后结果，包括急性肾损伤、胸部X线异常表现和住院时间。
肝切除术期间A组的SVV明显高于B组（11.0±1.7 vs 6.5±1.1，P<0.001）。A组的红细胞量损失明显低于B组（145.4±107.6 vs 307.9±110.7 mL，P<0.001）。A组的外科医生满意度评分高于B组（2.8±0.5 vs 2.0±0.6，P<0.001）。两组之间急性肾损伤、胸部X线异常表现的发生率和住院时间没有显著差异。
通过甘露醇给药维持高SVV对减少供体肝切除术期间的失血是有效且安全的。
