Department of Anaesthesiology, Affiliated Drum Tower Hospital, Nanjing University, School of Medicine, Nanjing, Jiangsu 210008, China.
Department of Hepatobiliary Pancreatic Surgery, Affiliated Drum Tower Hospital, Nanjing University, School of Medicine, Nanjing, Jiangsu 210008, China.
Chin Med J (Engl). 2023 Jul 5;136(13):1566-1572. doi: 10.1097/CM9.0000000000002484.
After major liver resection, the volume status of patients is still undetermined. However, few concerns have been raised about postoperative fluid management. We aimed to compare gut function recovery and short-term prognosis of the patients after laparoscopic liver resection (LLR) with or without inferior vena cava (IVC) respiratory variability-directed fluid therapy in the anesthesia intensive care unit (AICU).
This randomized controlled clinical trial enrolled 70 patients undergoing LLR. The IVC respiratory variability was used to optimize fluid management of the intervention group in AICU, while the standard practice of fluid management was used for the control group. The primary outcome was the time to flatus after surgery. The secondary outcomes included other indicators of gut function recovery after surgery, postoperative length of hospital stay (LOS), liver and kidney function, the severity of oxidative stress, and the incidence of severe complications associated with hepatectomy.
Compared with patients receiving standard fluid management, patients in the intervention group had a shorter time to anal exhaust after surgery (1.5 ± 0.6 days vs. 2.0 ± 0.8 days) and lower C-reactive protein activity (21.4 [95% confidence interval (CI): 11.9-36.7] mg/L vs. 44.8 [95%CI: 26.9-63.1] mg/L) 24 h after surgery. There were no significant differences in the time to defecation, serum concentrations of D -lactic acid, malondialdehyde, renal function, and frequency of severe postoperative complications as well as the LOS between the groups.
Postoperative IVC respiratory variability-directed fluid therapy in AICU was facilitated in bowel movement but elicited a negligible beneficial effect on the short-term prognosis of patients undergoing LLR.
ChiCTR-INR-17013093.
肝切除术后，患者的容量状态仍不确定。然而，术后液体管理方面的关注甚少。我们旨在比较腹腔镜肝切除（LLR）术后患者在麻醉重症监护病房（AICU）中采用下腔静脉（IVC）呼吸变异度指导的液体治疗与常规液体治疗对肠道功能恢复和短期预后的影响。
本随机对照临床试验纳入了 70 例接受 LLR 的患者。干预组在 AICU 中采用 IVC 呼吸变异度来优化液体管理，而对照组采用常规液体管理。主要结局是术后排气时间。次要结局包括术后肠道功能恢复的其他指标、术后住院时间（LOS）、肝肾功能、氧化应激严重程度以及与肝切除术相关的严重并发症发生率。
与接受标准液体管理的患者相比，干预组患者术后排气时间更短（1.5±0.6 天 vs. 2.0±0.8 天），术后 24 小时 C 反应蛋白活性更低（21.4[95%置信区间（CI）：11.9-36.7]mg/L vs. 44.8[95%CI：26.9-63.1]mg/L）。两组患者排便时间、血清 D-乳酸浓度、丙二醛浓度、肾功能以及严重术后并发症发生率和 LOS 均无显著差异。
AICU 中术后 IVC 呼吸变异度指导的液体治疗有助于促进肠道蠕动，但对 LLR 术后患者的短期预后几乎没有有益影响。
ChiCTR-INR-17013093。
