Phothikun Natsuda, Pantatong Orapan, Kulpanun Maytinee, Wongpunkamol Somchai, Lapisatepun Worakitti, Phothikun Amarit, Lapisatepun Warangkana
Department of Anesthesiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
Division of Hepato-biliary and Pancreas, Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
PLoS One. 2025 Apr 1;20(4):e0319856. doi: 10.1371/journal.pone.0319856. eCollection 2025.
Low central venous pressure (CVP) or fluid restriction strategies are frequently employed during liver parenchymal resection to minimize intraoperative blood loss. However, both hypovolemia and excessive fluid administration can impair organ perfusion, increasing the risk of renal dysfunction and acute kidney injury (AKI). This study explores the relationship between perioperative fluid management strategies and renal outcomes in patients undergoing hepatectomy.
A retrospective single-center cohort study was conducted involving 691 patients who underwent an open hepatectomy. Patients were categorized by positive fluid balance: <1 Liter, 1-2 Liters, and >2 Liters. Propensity score was used for matching among the groups. The incidence of acute kidney injury (AKI) was compared. Multivariable logistic regression analyzed the correlation between fluid balance and AKI risk.
The overall incidence of AKI was 11.58%, with the highest occurrence in the group with a fluid balance greater than 2 Liters. This group demonstrated a significantly higher relative risk of developing AKI compared to those with positive fluid balances of <1 Liter and 1-2 Liters (adjusted RR 1.85, p = 0.042, 95% CI 1.02-3.38). An increase in fluid balance was associated with a higher incidence rate ratio for AKI (p = 0.016). Additionally, an operating time >5 hours, blood loss >1000 ml, and Child-Turcotte-Pugh class B and C were significantly associated with an increased risk of post-hepatectomy AKI.
Maintaining a fluid balance of 1-2 liters during hepatectomy is crucial to reducing the risk of postoperative AKI, while balances above 2 liters significantly increase it. Prolonged operating times, high blood loss, and advanced liver disease also elevate AKI risk, emphasizing the need for careful fluid management.
在肝实质切除术中，常采用低中心静脉压（CVP）或液体限制策略以尽量减少术中失血。然而，血容量不足和过多的液体输注都会损害器官灌注，增加肾功能不全和急性肾损伤（AKI）的风险。本研究探讨肝切除术患者围手术期液体管理策略与肾脏结局之间的关系。
进行了一项回顾性单中心队列研究，纳入691例行开放性肝切除术的患者。根据液体平衡情况将患者分为：<1升、1 - 2升和>2升。采用倾向评分在各组间进行匹配。比较急性肾损伤（AKI）的发生率。多变量逻辑回归分析液体平衡与AKI风险之间的相关性。
AKI的总体发生率为11.58%，在液体平衡大于2升的组中发生率最高。与液体平衡<1升和1 - 2升的组相比，该组发生AKI的相对风险显著更高（校正RR 1.85，p = 0.042，95% CI 1.02 - 3.38）。液体平衡增加与AKI的发病率比值升高相关（p = 0.016）。此外，手术时间>5小时、失血>1000毫升以及Child-Turcotte-Pugh B级和C级与肝切除术后AKI风险增加显著相关。
肝切除术中维持1 - 2升的液体平衡对于降低术后AKI风险至关重要，而超过2升的液体平衡会显著增加该风险。手术时间延长、失血量大和晚期肝病也会增加AKI风险，强调了谨慎进行液体管理的必要性。
