肝移植后预测液体反应性的迷你液体挑战的有效性。
Validity of mini-fluid challenge for predicting fluid responsiveness following liver transplantation.
机构信息
Department of Anesthesia, Surgical Intensive Care and Pain Management, Faculty of Medicine, Cairo University, Cairo, Egypt.
, Cairo, Egypt.
出版信息
BMC Anesthesiol. 2019 Apr 13;19(1):56. doi: 10.1186/s12871-019-0728-4.
BACKGROUND
Mini-fluid challenge is a well tested and effective tool to predict fluid responsiveness under various clinical conditions. However, mini-fluid challenge has never been tested in patients with end-stage liver disease. This study investigated whether infusion of 150 ml albumin 5% can predict fluid responsiveness in cirrhotic patients following liver transplant.
METHODS
Fifty patients receiving living donor liver transplant were included in the analysis. Mini-fluid challenge composed of 150 ml of albumin 5% administered over 1 min in three consecutive 50-ml fluid boluses. An additional 350 ml was then infused at a constant rate over 15 min (for a total of 500 ml). Stroke volume (SV) was measured as the product of the subaortic velocity time integral (VTI) and left ventricular outflow tract (LVOT) area. Fluid responsiveness was defined as an increase in SV by ≥15% after the infusion.
RESULTS
Fifty patients were enrolled in the study. Fourteen patients were classified with Child A, 15 patients with Child B, and 21 patients with Child C cirrhosis. Thirty four patients were fluid responders and 16 patients were fluid non-responders. After 150 ml of albumin 5%, the SV increased significantly in our cohort. The area under receiver operating curve (AUROC) was 0.7 (95% confidence interval [CI] 0.5-0.8, P = 0.005). In subgroup analysis, the SV increased significantly after mini fluid challenge in the Child A group (P = 0.017) but not Child B or C groups (P = 0.3 and 0.29, respectively). The AUROC for mini-fluid challenge in the Child A group was 0.86 (95% confidence interval [CI] 0.6-0.9, P = 0.0004), while mini-fluid challenge failed to discriminate between responders and non-responders in Child B and C groups.
CONCLUSION
A mini-fluid challenge of 150 ml albumin 5% can predict fluid responsiveness in liver transplant patients with fair sensitivity and specifiicty. Subgroup analyis revealed that minifluid challenge can predict fluid responsiveness in patients with Child A cirrhosis but not patients with Child B or C cirrhosis.
TRIAL REGISTRATION
NCT03396159 . (Prospective registered). Initial registration date was 10/01/2018.
背景
微量输液试验是一种经过充分验证和有效的工具，可在各种临床情况下预测液体反应性。然而，微量输液试验从未在终末期肝病患者中进行过测试。本研究旨在探讨在活体供肝移植的患者中，输注 150ml 白蛋白 5%能否预测液体反应性。
方法
本研究共纳入 50 例接受活体供肝移植的患者。微量输液试验由三部分组成，每部分先输注 50ml 白蛋白 5%，持续 1 分钟，然后再输注另外 350ml 白蛋白 5%，持续 15 分钟（共 500ml）。心输出量（SV）通过主动脉下速度时间积分（VTI）和左心室流出道（LVOT）面积的乘积来测量。液体反应性定义为输液后 SV 增加≥15%。
结果
本研究共纳入 50 例患者。14 例患者为 Child A 级，15 例患者为 Child B 级，21 例患者为 Child C 级肝硬化。34 例患者为液体反应者，16 例患者为液体无反应者。在输注 150ml 白蛋白 5%后，我们的研究队列中 SV 显著增加。受试者工作特征曲线（ROC）下面积为 0.7（95%置信区间[CI] 0.5-0.8，P=0.005）。亚组分析显示，在 Child A 组中，微量输液试验后 SV 显著增加（P=0.017），而在 Child B 组和 Child C 组中，SV 没有显著增加（P=0.3 和 0.29）。Child A 组微量输液试验的 ROC 为 0.86（95%置信区间[CI] 0.6-0.9，P=0.0004），而微量输液试验无法区分 Child B 组和 Child C 组中液体反应者和无反应者。
结论
150ml 白蛋白 5%的微量输液试验可预测肝移植患者的液体反应性，具有良好的敏感性和特异性。亚组分析显示，微量输液试验可预测 Child A 级肝硬化患者的液体反应性，但不能预测 Child B 级或 Child C 级肝硬化患者的液体反应性。
试验注册
NCT03396159（前瞻性注册）。首次注册日期为 2018 年 10 月 1 日。
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