目标导向液体治疗在肝移植术后液体管理中的应用

Application of goal-directed fluid therapy in fluid management after liver transplantation

目的探讨目标导向液体治疗(GDT)在肝移植患者术后液体管理中应用的安全性和有效性。方法本前瞻性研究对象为2015年1月至2016年7月在西安交通大学第一附属医院行原位肝移植术的109例患者。根据术后处理措施不同将患者分为GDT组和对照组。其中GDT组51例,男38例,女13例;平均年龄(45±18)岁;采用GDT方案。对照组58例,男43例,女15例;年龄(47±17)岁;采用常规肝移植术后处理措施。患者均签署知情同意书,符合医学伦理学规定。两组首次排气时间、排便时间及术后ICU住院时间比较采用t检验;并发症发生率比较采用χ~2检验。结果原位肝移植术后,GDT组术后首次排气时间、排便时间、ICU住院时间分别为(2.1±0.4)、(3.1±1.3)、(3.5±0.9)d,明显短于对照组的(3.2±2.1)、(4.9±1.8)、(5.4±1.3)d(t=-3.681,-5.912,-8.753;P<0.05)。GDT组术后容量相关并发症发生率为10%(5/51),明显低于对照组的26%(15/58)(χ~2=4.671,P<0.05)。结论 GDT在肝移植术后液体管理中是安全、有效的,可加速患者术后康复。

Objective To investigate the safety and effectiveness of application of goal-directed fluid therapy （GDT） in the fluid management after liver transplantation （LT）. Methods One hundred and nine patients who underwent orthotopic LT in the First Affiliated Hospital of Xi＇an Jiaotong University between January 2015 and July 2016 were enrolled in this prospective study. According to the postoperative manage measures, the patients were divided into the GDT group （n=51） and control group （n=58）. In the GDT group, 38 cases were males and 13 were females, aged （45±18） years old on average, and GDT was used in the patients. In the control group, 43 cases were males and 15 were females, aged （47±17） years old on average, and conventional postoperative manage measures were used in the patients. The informed consents of all patients were obtained and the local ethical committee approval was received. The first exhaust time, defecation time and postoperative length of ICU stay in two groups were compared using t test. The incidence of complications was compared using Chi-square test. Results The first exhaust time, defecation time and length of ICU stay after orthotopic LT in the GDT group was respectively （2.1±0.4）, （3.1±1.3）, （3.5±0.9） d, significantly shorter than （3.2±2.1）, （4.9±1.8） and （5.4±1.3） d in the control group （t=-3.681, -5.912, -8.753; P〈0.05）. The incidence of postoperative volume-related complications in the GDT group was 10%（5/51）, significantly lower than 26%（15/58） in the control group 0（2=4.671, P〈0.05）. Conclusions GDT is a safe and efficacious approach for fluid management after LT, and it cad accelerate the postoperative recovery of the oatients.