Tu Zhen-Zhen, Bai Lin, Dai Xiao-Ke, He Dong-Wei, Song Juan, Zhang Ming-Man
Department of Anesthesiology, Children's Hospital of Chongqing Medical University, Chongqing, 400016, China.
Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, 400016, China.
BMC Surg. 2024 Aug 7;24(1):225. doi: 10.1186/s12893-024-02520-1.
Pediatric patients undergoing liver transplantation are particularly susceptible to complications arising from intraoperative fluid management strategies. Conventional liberal fluid administration has been challenged due to its association with increased perioperative morbidity. This study aimed to assess the impact of intraoperative high-volume fluid therapy on pediatric patients who are undergoing living donor liver transplantation (LDLT).
Conducted at the Children's Hospital of Chongqing Medical University from March 2018 to April 2021, this retrospective study involved 90 pediatric patients divided into high-volume and non-high-volume fluid administration groups based on the 80th percentile of fluid administered. We collected the perioperative parameters and postoperative information of two groups. Multivariable logistic regression was utilized to assess the association between estimated blood loss (EBL) and high-volume FA. Kaplan-Meier survival analysis was used to compare patient survival after pediatric LDLT.
Patients in the high-volume FA group received a higher EBL and longer length of stay than that in the non-high-volume FA group. Multivariate logistic regression analysis indicated that hours of maintenance fluids and fresh frozen plasma were significantly associated risk factors for the occurrence of EBL during pediatric LDLT. In addition, survival analysis showed no significant differences in one-year mortality between the groups.
High-volume fluid administration during LDLT is linked with poorer intraoperative and postoperative outcomes among pediatric patients. These findings underscore the need for more conservative fluid management strategies in pediatric liver transplantations to enhance recovery and reduce complications.
接受肝移植的儿科患者特别容易受到术中液体管理策略引发的并发症影响。传统的自由液体输注因与围手术期发病率增加有关而受到质疑。本研究旨在评估术中大量液体疗法对接受活体肝移植（LDLT）的儿科患者的影响。
本回顾性研究于2018年3月至2021年4月在重庆医科大学附属儿童医院进行，纳入90例儿科患者，根据输注液体的第80百分位数分为大量液体输注组和非大量液体输注组。我们收集了两组的围手术期参数和术后信息。采用多变量逻辑回归评估估计失血量（EBL）与大量液体输注之间的关联。采用Kaplan-Meier生存分析比较儿科LDLT术后患者的生存率。
大量液体输注组患者的EBL更高，住院时间比非大量液体输注组更长。多变量逻辑回归分析表明，维持液和新鲜冰冻血浆的输注时间是儿科LDLT期间发生EBL的显著相关危险因素。此外，生存分析显示两组之间的一年死亡率无显著差异。
LDLT期间大量液体输注与儿科患者较差的术中和术后结果相关。这些发现强调了在儿科肝移植中需要更保守的液体管理策略，以促进恢复并减少并发症。
