The importance of the safety of healthy living liver donors is widely recognized during donor hepatectomywhich is associated with blood loss, transfusion, and subsequent post-operative morbidity. Although the low cent...The importance of the safety of healthy living liver donors is widely recognized during donor hepatectomywhich is associated with blood loss, transfusion, and subsequent post-operative morbidity. Although the low central venous pressure(CVP) technique can still be effective, it may not be advantageous concerning the safety of healthy donors undergoing hepatectomy. Emerging evidence suggests that stroke volume variation(SVV), a simple and useful index for fluid responsiveness and preload status in various clinical situations, can be applied as a guide for fluid management to reduce blood loss during living donor hepatectomy. Synthetic colloid solutions are also associated with serious adverse events such as the use of renal replacement therapy and transfusion in critically ill or septic patients. However, it is uncertain whether the intra-operative use of colloid solution is associated with similarly adverse effects in patients undergoing living donor hepatectomy. In this review article we discuss the recent issues regarding the low CVP technique and the high SVV method, i.e., maintaining 10%-20% of SVV, for fluid management in order to reduce blood loss during living donor hepatectomy. In addition, we briefly discuss the effects of intra-operative colloid or crystalloid administration for surgical rather than septic or critically ill patients.展开更多
文摘The importance of the safety of healthy living liver donors is widely recognized during donor hepatectomywhich is associated with blood loss, transfusion, and subsequent post-operative morbidity. Although the low central venous pressure(CVP) technique can still be effective, it may not be advantageous concerning the safety of healthy donors undergoing hepatectomy. Emerging evidence suggests that stroke volume variation(SVV), a simple and useful index for fluid responsiveness and preload status in various clinical situations, can be applied as a guide for fluid management to reduce blood loss during living donor hepatectomy. Synthetic colloid solutions are also associated with serious adverse events such as the use of renal replacement therapy and transfusion in critically ill or septic patients. However, it is uncertain whether the intra-operative use of colloid solution is associated with similarly adverse effects in patients undergoing living donor hepatectomy. In this review article we discuss the recent issues regarding the low CVP technique and the high SVV method, i.e., maintaining 10%-20% of SVV, for fluid management in order to reduce blood loss during living donor hepatectomy. In addition, we briefly discuss the effects of intra-operative colloid or crystalloid administration for surgical rather than septic or critically ill patients.
文摘目的:探讨中医特色护理干预在脑卒中后吞咽障碍患者容积-黏度吞咽测试(volume viscos-ity screening test,V-VST)结合间歇性管饲中的护理效果及对功能恢复的影响。方法:选择脑卒中后吞咽障碍患者60例,按照随机数字表法分为对照组和观察组,每组30例。对照组给予常规护理,观察组在对照组的基础上给予中医特色护理。观察两组患者的护理质量、格拉斯哥昏迷评分(Glasgow coma scale,GCS)、日常生活能力评分(activity of daily living,ADL)、住院时间、并发症发生率和功能恢复率、吞咽功能评分、焦虑评分、抑郁评分。结果:观察组护理质量评分显著优于对照组(P<0.05);观察组GCS评分和ADL评分明显高于对照组(P<0.05);观察组功能恢复率显著高于对照组(P<0.05),且术后患者住院时间、并发症发生率明显低于对照组(P<0.05);观察组吞咽功能评分显著高于对照组(P<0.05);观察组焦虑、抑郁评分显著低于对照组(P<0.05)。结论:中医特色护理干预在脑卒中后吞咽障碍患者V-VST结合间歇性管饲中的护理效果显著,可促进患者功能恢复,改善患者焦虑抑郁状态,进而提高患者生活质量。
