Background:Isotonic crystalloids are recommended as the first choice for fluid therapy in acute pan-creatitis(AP),with normal saline(NS)and lactate Ringer’s(LR)used most often.Evidence based recom-mendations on the t...Background:Isotonic crystalloids are recommended as the first choice for fluid therapy in acute pan-creatitis(AP),with normal saline(NS)and lactate Ringer’s(LR)used most often.Evidence based recom-mendations on the type of fluid are conflicting and generally come from small single-center randomized controlled trials(RCTs).We therefore conducted a systematic review and meta-analysis to compare the effect of balanced solutions(BS)versus NS on patient-centered clinical outcomes in AP.Methods:From four databases searched up to October 2024,we included only RCTs of adult patients with AP that compared the use of BS(including LR,acetate Ringer’s,etc.)with NS.The primary out-come was the disease advances from AP to moderately severe and severe AP(MSAP/SAP).Trial sequential analyses(TSA)were conducted to control for type-I and type-II errors and Grading of Recommendations Assessment,Development,and Evaluation(GRADE)was used to assess the quality of evidence.Results:Six RCTs were identified and included,involving 260 patients treated with BS and 298 patients with NS.Patients who received the BS had less MSAP/SAP[odds ratio(OR)=0.50,95%confidence in-terval(CI):0.29 to 0.85,P=0.01,I^(2)=0%;5 studies,299 patients],reduced the need of ICU admission(OR=0.60,95%CI:0.39 to 0.93,P=0.02,I^(2)=0%;5 studies,507 patients)and shorter length of hospital stay[mean difference(MD)=-0.88,95%CI:-1.48 to-0.28,P=0.004,I^(2)=0%;6 studies,558 patients;confirmed by TSA with high certainty]compared with those who received NS.The evidence for most of the clinical outcomes was rated as moderate to low due to the risk of bias,imprecision and inconsistency.Conclusions:BS,compared with NS,was associated with improved clinical outcomes in patients with AP.However,given the moderate to low quality of evidence for most of the outcomes assessed,further trials are warranted.展开更多
Microbial infection is a principal etiological factor in pulp and periapical diseases,necessitating effective root canal therapy(RCT)for thorough decontamination of the root canal system.However,conventional mechanica...Microbial infection is a principal etiological factor in pulp and periapical diseases,necessitating effective root canal therapy(RCT)for thorough decontamination of the root canal system.However,conventional mechanical and chemical preparation methods remain inadequate,often leaving significant portions of the canal uncleaned and contributing to persistent infection.The advent of erbium laser-assisted chemical preparation has demonstrated significant potential in enhancing root canal disinfection through advanced fluid dynamics mechanisms,particularly cavitation and photoacoustic streaming.This review explores the fundamental principles governing fluid dynamics in erbium laser-assisted irrigation,with a focus on primary and secondary cavitation effects.The interaction between erbium laser energy and water generates vapor bubbles that induce dynamic fluid movement,enhancing the penetration and distribution of irrigants deep within the root canal system.Key factors influencing fluid dynamics intensity,including laser parameters,working tip design,and water medium confinement,are critically analyzed.Furthermore,recent advancements such as Photon-Initiated Photoacoustic Streaming(PIPS),Photoacoustic Synchronized Transients(PHAST),and Shock Wave Enhanced Emission Photoacoustic Streaming(SWEEPS)are reviewed in the context of their ability to improve fluid motion and irrigation efficacy.While these laser-assisted techniques offer promising improvements over traditional methods,challenges remain in optimizing energy parameters and mitigating the constraints imposed by confined root canal environments.Future research should focus on refining fluid dynamics models and conducting clinical studies to validate the efficacy of these innovations.This review aims to provide a comprehensive overview of current developments in fluid dynamics research related to erbium laser-assisted chemical preparation,offering insights into its potential as an advanced modality for root canal disinfection.展开更多
BACKGROUND An investigation is undertaken to assess the effects of permissive hypercapnia(PH)combined with goal-directed fluid therapy(GDFT)on postoperative recovery and psychological well-being among elderly patients...BACKGROUND An investigation is undertaken to assess the effects of permissive hypercapnia(PH)combined with goal-directed fluid therapy(GDFT)on postoperative recovery and psychological well-being among elderly patients undergoing laparoscopic surgical procedures.AIM To ascertain whether the combination of PH and GDFT improves clinical recovery indicators,reduces postoperative complications,and alleviates anxiety,depression,and inflammatory responses in this specific patient population.METHODS A total of 120 elderly patients who underwent laparoscopic surgery in our hospital from July 2023 to June 2024 were randomly allocated into two groups:A control group(n=60)and a study group(n=60).In the control group,conventional anesthesia ventilation and fluid management protocols were administered,while in the study group,PH(with intraoperative PaCO_(2) maintained between 45-55 mmHg)was combined with GDFT.Postoperative recovery indicators,including the time to first flatus,time to ambulation,and length of hospital stay,were compared between the groups.Additionally,complication rates,anxietydepression scores assessed via the Hospital Anxiety and Depression scale,and levels of inflammatory factors were analyzed to evaluate the outcomes.RESULTS When compared with the control group,the study group demonstrated significantly shorter time to first flatus[(48.3±6.2)hours vs(62.5±7.8)hours],time to ambulation[(28.4±4.2)hours vs(38.6±5.1)hours],and length of hospital stay[(5.2±1.1)days vs(7.4±1.3)days](P<0.05).A significantly lower postoperative complication rate was observed in the study group(8.3%vs 21.7%,P<0.05).Additionally,at 3 days postoperatively,significantly lower anxiety scores[(5.2±1.4)vs(7.8±1.6)]and depression scores[(4.8±1.2)vs(7.1±1.5)]were recorded in the study group compared to the control group(P<0.05);Furthermore,at 24 hours postoperatively,serum levels of interleukin-6,tumor necrosis factorα,and C-reactive protein were found to be significantly lower in the study group than in the control group(P<0.05).CONCLUSION Postoperative recovery is significantly expedited,postoperative complications are markedly reduced,anxietydepression status is substantially improved,and inflammatory response is notably diminished in elderly patients undergoing laparoscopic surgery when PH is combined with GDFT,thereby making it worthy of clinical application.展开更多
Background Continuous renal replacement therapy(CRRT)is frequently applied in critically ill patients with acute kidney injury who are vulnerable to cardiovascular complications.Differences in calcium management durin...Background Continuous renal replacement therapy(CRRT)is frequently applied in critically ill patients with acute kidney injury who are vulnerable to cardiovascular complications.Differences in calcium management during CRRT may affect cardiac electrophysiology and hemodynamic stability,potentially influencing cardiovascular outcomes.Methods A total of 96 patients receiving CRRT were enrolled in this single-center study between September 2020 and September 2023.Patients were divided into two groups:those receiving calcium-containing replacement fluids(n=46)and those receiving calcium-free fluids(n=50).Clinical outcomes,including major adverse cardiovascular events(MACE),arrhythmias,hypotension,myocardial infarction,sudden cardiac arrest,intensive care units(ICU)stays,and hospital mortality,were compared between the two groups.Results The calcium-containing group had a significantly lower incidence of MACE(20%vs.32%,P<0.001)and arrhythmias(8%vs.17.3%,P=0.010)compared to the calcium-free group.ICU stays were also shorter in the calcium-containing group(11.6±8.8 days vs.16.6±7.6 days,P=0.004).Hospital mortality showed a trend toward being lower in the calciumcontaining group,though this was not statistically significant(0.6%vs.10.1%,P=0.063).No significant differences were observed in the incidence of hypotension,myocardial infarction,or sudden cardiac arrest.Conclusions Calcium-containing replacement fluids during CRRT were associated with improved clinical outcomes,including lower rates of MACE and arrhythmias,as well as shorter ICU stays.This simplified approach may be safer and more efficient,but larger studies are needed to confirm these findings and assess long-term outcomes.展开更多
BACKGROUND Acute pancreatitis(AP)is a frequent gastrointestinal emergency characterized by inflammation.It has the potential to progress to organ failure.Fluid therapy plays a critical role in early AP management,miti...BACKGROUND Acute pancreatitis(AP)is a frequent gastrointestinal emergency characterized by inflammation.It has the potential to progress to organ failure.Fluid therapy plays a critical role in early AP management,mitigating hypovolemia-induced ischemia and systemic inflammatory response syndrome(SIRS).AIM To evaluate dextran 40+Ringer’s lactate solution(RLS)vs RLS alone for fluid therapy in mild to moderate AP.METHODS We conducted a single-center,single-blind,randomized controlled trial involving 108 patients with mild to moderate AP.Participants were randomized to receive either dextran 40+RLS(1:3 ratio)or RLS alone.All patients underwent standardized,goal-directed fluid therapy and were monitored for clinical response,inflammatory markers,and complications.The primary outcomes were reduction in C-reactive protein(CRP)and resolution of SIRS at 72 hours.Secondary outcomes included organ failure,intensive care unit admission,mortality,and length of hospital stay.RESULTS The dextran 40+RLS group demonstrated significantly lower CRP levels.No differences were observed in SIRS changes,fluid overload,refractory status mortality,local complications,or organ failure rates.Hospitalization tended to be shorter in the dextran 40+RLS group(5 days vs 6 days)although not to a statistically significant level(P=0.1).Adverse events were mild and comparable in both groups.CONCLUSION Dextran 40+RLS improved the early CRP response in patients with AP without added complications.Although medium-term outcomes were similar,early benefits support its use in initial management.展开更多
BACKGROUND: Although liver transplantation (LT) has made rapid progress, early pulmonary complications still occur. More attention should be paid to fluid therapy that may be an important factor leading to these compl...BACKGROUND: Although liver transplantation (LT) has made rapid progress, early pulmonary complications still occur. More attention should be paid to fluid therapy that may be an important factor leading to these complications. It is necessary to investigate the correlation between intraoperative and postoperative fluid therapy and early pulmonary complications after LT, then attempt to provide a reasonable fluid therapy in the perioperative period. METHODS: Sixty-two patients who had undergone Ff were enrolled and analyzed retrospectively. Based on early phase prognosis after LT, the 62 patients were divided into a non-pulmonary complication group and a pulmonary complication group. Twenty perioperative variables were analyzed in both groups to screen out several factors causing early pulmonary complications, then the parameters reflecting postoperative recovery were analyzed. RESULTS: The pulmonary complication group had 29 patients (46.77%), 3 (4.84%) of whom died during the perioperative period. Using monofactorial analysis for each variable, the two groups differed in the following variables: preoperative lung function, volume of intraoperative transfusion, volume of intraoperative bleeding, and volume of intraoperative net fluid retention and fluid balance (<=-500 ml) in >= 2 of the first 3 days after operation. Analysis of the relationship between multivariate factors and pulmonary complications after LT by logistic multivariate regression analysis showed that preoperative lung function, volume of intraoperative bleeding, and fluid balance (<=-500 ml) in >=-2 of the first 3 days after operation were influential factors. CONCLUSIONS: It is important to maintain fluid balance during the perioperative period of LT. If the hemodynamics are stable, appropriate negative fluid balance in the first 3 days after operation apparently decreases the incidence of early pulmonary complications after LT. These measures are associated with better postoperative recovery.展开更多
Intraoperative fluid management is pivotal to the outcome and success of surgery, especially in high-risk proce- dures. Empirical formula and invasive static monitoring have been traditionally used to guide intraopera...Intraoperative fluid management is pivotal to the outcome and success of surgery, especially in high-risk proce- dures. Empirical formula and invasive static monitoring have been traditionally used to guide intraoperative fluid management and assess volume status. With the awareness of the potential complications of invasive procedures and the poor reliability of these methods as indicators of volume status, we present a case scenario of a patient who underwent major abdominal surgery as an example to discuss how the use of minimally invasive dynamic monitoring may guide intraoperative fluid therapy.展开更多
AIM: To investigate the effect of perioperative restricted fluid therapy on circulating CD4<sup>+</sup>/CD8<sup>+</sup> T lymphocyte ratio, percentage of regulatory T cells (Treg) and postopera...AIM: To investigate the effect of perioperative restricted fluid therapy on circulating CD4<sup>+</sup>/CD8<sup>+</sup> T lymphocyte ratio, percentage of regulatory T cells (Treg) and postoperative complications in patients with colorectal cancer.展开更多
AIM:To investigate the correlation between peri-operative fluid therapy and early-phase recovery after liver transplantation(LT) by retrospectively reviewing 102 consecutive recipients.METHODS:Based on whether or not ...AIM:To investigate the correlation between peri-operative fluid therapy and early-phase recovery after liver transplantation(LT) by retrospectively reviewing 102 consecutive recipients.METHODS:Based on whether or not the patients had pulmonary complications,the patients were categorized into non-pulmonary and pulmonary groups.Twentyeight peri-operative variables were analyzed in both groups to screen for the factors related to the occurrence of early pulmonary complications.RESULTS:The starting hemoglobin(Hb) value,an intra-operative transfusion > 100 mL/kg,and a fluid balance ≤-14 mL/kg on the first day and the second or third day post-operatively were significant factors for early pulmonary complications.The extubation time,time to initial passage of flatus,or intensive care unit length of stay were significantly prolonged in patients who had not received an intra-operative transfusion ≤ 100 mL/kg or a fluid balance ≤-14 mL/kg on the first day and the second or the third day post-operatively.Moreover,these patients had poorer results in arterial blood gas analysis.CONCLUSION:It is important to offer a precise and individualized fluid therapy during the peri-operative period to the patients undergoing LT for cirrhosis-associated hepatocellular carcinoma.展开更多
Fluid therapy is perhaps the most common intervention received by acutely ill hospitalized patients; however, a number of critical questions on the efficacy and safety of the type and dose remain. In this review, rece...Fluid therapy is perhaps the most common intervention received by acutely ill hospitalized patients; however, a number of critical questions on the efficacy and safety of the type and dose remain. In this review, recent insights derived from randomized trials in terms of fluid type, dose and toxicity are discussed. We contend that the prescription of fluid therapy is context-specific and that any fluid can be harmful if administered inappropriately. When contrasting ‘‘crystalloid vs colloid'', differences in efficacy are modest but differences in safety are significant. Differences in chloride load and strong ion difference across solutions appear to be clinically important. Phases of fluid therapy in acutely ill patients are recognized, including acute resuscitation, maintaining homeostasis, and recovery phases. Quantitative toxicity(fluid overload) is associated with adverse outcomes and can be mitigated when fluid therapy basedon functional hemodynamic parameters that predict volume responsiveness and minimization of non-essential fluid. Qualitative toxicity(fluid type), in particular for iatrogenic acute kidney injury and metabolic acidosis, remain a concern for synthetic colloids and isotonic saline, respectively. Physiologically balanced crystalloids may be the ‘‘default'' fluid for acutely ill patients and the role for colloids, in particular hydroxyethyl starch, is increasingly unclear. We contend the prescription of fluid therapy is analogous to the prescription of any drug used in critically ill patients.展开更多
Objective Although goal-directed fluid therapy(GDFT)has been proven to be effective in reducing the incidence of postoperative complications,the underlying mechanisms remain unknown.The aim of this study was to examin...Objective Although goal-directed fluid therapy(GDFT)has been proven to be effective in reducing the incidence of postoperative complications,the underlying mechanisms remain unknown.The aim of this study was to examine the mediating role of intraoperative hemodynamic lability in the association between GDFT and the incidence of postoperative complications.We further tested the role of this mediation effect using mean arterial pressure,a hemodynamic indicator.Methods This secondary analysis used the dataset of a completed nonrandomized controlled study to investigate the effect of GDFT on the incidence of postoperative complications in patients undergoing posterior spine arthrodesis.We used a simple mediation model to test whether there was a mediation effect of average real variability between the association of GDFT and postoperative complications.We conducted mediation analysis using the mediation package in R(version 3.1.2),based on 5,000 bootstrapped samples,adjusting for covariates.Results Among the 300 patients in the study,40%(120/300)developed postoperative complications within 30 days.GDFT was associated with fewer 30-day postoperative complications after adjustment for confounders(odds ratio:0.460,95%CI:0.278,0.761;P=0.003).The total effect of GDFT on postoperative complications was-0.18(95%CI:-0.28,-0.07;P<0.01).The average causal mediation effect was-0.08(95%CI:-0.15,-0.04;P<0.01).The average direct effect was-0.09(95%CI:-0.20,0.03;P=0.17).The proportion mediated was 49.9%(95%CI:18.3%,140.0%).Conclusions The intraoperative blood pressure lability mediates the relationship between GDFT and the incidence of postoperative complications.Future research is needed to clarify whether actively reducing intraoperative blood pressure lability can prevent postoperative complications.展开更多
BACKGROUND Intraoperative fluid management is an important aspect of anesthesia mana-gement in gastrointestinal surgery.Intraoperative goal-directed fluid therapy(GDFT)is a method for optimizing a patient's physio...BACKGROUND Intraoperative fluid management is an important aspect of anesthesia mana-gement in gastrointestinal surgery.Intraoperative goal-directed fluid therapy(GDFT)is a method for optimizing a patient's physiological state by monitoring and regulating fluid input in real-time.AIM To evaluate the efficacy of intraoperative GDFT in patients under anesthesia for gastrointestinal surgery.METHODS This study utilized a retrospective comparative study design and included 60 patients who underwent gastrointestinal surgery at a hospital.The experimental group(GDFT group)and the control group,each comprising 30 patients,received intraoperative GDFT and traditional fluid management strategies,respectively.The effect of GDFT was evaluated by comparing postoperative recovery,com-plication rates,hospitalization time,and other indicators between the two patient groups.RESULTS Intraoperative blood loss in the experimental and control groups was 296.64±46.71 mL and 470.05±73.26 mL(P<0.001),and urine volume was 415.13±96.72 mL and 239.15±94.69 mL(P<0.001),respectively.The postoperative recovery time was 5.44±1.1 days for the experimental group compared to 7.59±1.45 days(P<0.001)for the control group.Hospitalization time for the experimental group was 10.87±2.36 days vs 13.65±3 days for the control group(P<0.001).The visual analogue scale scores of the experimental and control groups at 24 h and 48 h INTRODUCTION Gastrointestinal surgery is one of the most common procedures in the field of general surgery[1],involving the stomach,intestines,liver,pancreas,spleen,and other internal abdominal organs[2,3].With advancements in surgical technology and anesthesia methods,the safety and success rates of surgery have significantly improved[4,5].However,intraop-erative fluid management remains a critical challenge[6].Traditional fluid management strategies often rely on experience and basic physiological parameters,which may lead to excessive or insufficient fluid input,thereby affecting postoperative recovery and complication rates.Intraoperative goal-directed fluid therapy(GDFT)is an emerging fluid management strategy that dynamically adjusts fluid input volume by monitoring the patient's hemodynamic parameters in real-time to optimize the patient's physiological state[7,8].GDFT has shown superiority in many surgical fields;however,its application in gastrointestinal surgery requires further research and verification[9,10].The application of intraoperative GDFT in clinical settings has gradually increased in recent years[11,12].Studies have demonstrated that GDFT can optimize tissue perfusion and oxygenation by precisely controlling fluid input and reducing the occurrence of postoperative complications[13,14].For example,in cardiac and major vascular surgeries,GDFT significantly reduced the incidence of postoperative acute kidney injury and cardiovascular events[15,16].Similarly,in abdominal surgery,GDFT effectively reduced postoperative infections and expedited recovery[17].However,studies on the utilization of GDFT in gastrointestinal surgery are relatively limited and they are confounded by contradictory findings[18].Traditional fluid management strategies typically rely on estimating fluid input volume based on the patient's weight,preoperative status,and basic physiological parameters[19].However,this method lacks real-time dynamic adjustment,which may result in either insufficient or excessive fluid input,consequently affecting postoperative recovery.Insufficient fluid input can lead to hypovolemia and inadequate tissue perfusion,whereas excessive fluid input can cause tissue edema and postoperative complications,such as pulmonary edema and heart failure.GDFT involves dynamically adjusting fluid input volume by monitoring the patient's hemodynamic parameters in real-time,such as cardiac output,pulse pressure variability,and central venous pressure.Commonly used monitoring equipment include esophageal Doppler and pulse wave profile analyzers[20].These devices provide real-time hemo-dynamic data to assist anesthesiologists in tailoring fluid therapy to a patient's specific condition.Firstly,the patient's volume responsiveness is assessed by preloading fluid;secondly,fluid input volume is dynamically adjusted based on real-time monitoring data;finally,vasoactive and inotropic drugs are administered in combination to further optimize the patient’s hemodynamic status.Through personalized fluid management,GDFT can more accurately maintain intraop-erative hemodynamic stability and reduce complications[21].Gastrointestinal surgery involves procedures on multiple organs,often requiring prolonged operative times and extensive tissue trauma,which presents challenges for intraop-erative fluid management.Surgical procedures can lead to significant bleeding and fluid loss,requiring prompt and effective fluid replenishment.In addition,the slow recovery of gastrointestinal function after surgery and susceptibility to complications such as intestinal obstruction and delayed gastric emptying elevate the necessity for postoperative fluid management.展开更多
Fifty dogs were inflicted with burn-blast combined injury and divided into 5 groups. All the experimental animals began to receive various amounts of fluid and sodium slat replacement 2 h after injury. Serum level of ...Fifty dogs were inflicted with burn-blast combined injury and divided into 5 groups. All the experimental animals began to receive various amounts of fluid and sodium slat replacement 2 h after injury. Serum level of endogenous digitalis-like factor (EDLF展开更多
Objective: It has been suggested that the use of hypotonic intravenous fluid (IVF) puts hospitalized children at a greater risk of developing hyponatremia in children with increased arginine vasopressin (AVP) producti...Objective: It has been suggested that the use of hypotonic intravenous fluid (IVF) puts hospitalized children at a greater risk of developing hyponatremia in children with increased arginine vasopressin (AVP) production. To reduce its risk, the National Patient Safety Agency in UK issued alert 22 in 2007, of which recommendations were to use isotonic solutions for these children at risk of hyponatremia, instead of the previously most commonly used IVF (0.18% saline/ 4% dextrose) for maintenance fluid therapy. Recent observations, however, revealed that hypokalemia are also common in hospitalized patients who do not receive potassium in their IVF. This study was conducted to validate the potassium added IVF for the prevention of hospital-acquired hypokalemia in maintenance fluid therapy. Design: For maintenance fluid therapy, a commercially available IVF solution in Japan named as Solita-T2R (Na 84 mmol/L, K 20 mmol/L, Cl 66 mmol/L, glucose 3.2%) was infused for 41 sick children with a median age of 3.01 years. Its composition is close equivalent to 0.45% saline/5% dextrose (Na 77 mmol/L, K 0 mmol/L, Cl 77 mmol/L, dextrose 5%) except K content. The patients in states of AVP excess were excluded from the analysis. Results: Median serum potassium value did not drop significantly at a median interval of 48 hours (before IVF: 4.30 mmol/L, after IVF: 4.10 mmol/L, p > 0.05), whereas median serum sodium level significantly increased from 136.0 mmol/L to 139.0 mmol/L (p < 0.001). Conclusion: Potassium added (20 mmol/L) IVF solution reduces the risk of developing “hospital-acquired hypokalemia” in children who are not in states of AVP excess in maintenance fluid therapy. It is worthwhile to study prospectively in a larger number of sick children.展开更多
Objective:To investigate the effects of perioperative goal-directed fluid therapy(GDFT)on intraoperative fluid balance,postoperative morbidity,and mortality.Methods:This is a prospective randomized study,and 90 patien...Objective:To investigate the effects of perioperative goal-directed fluid therapy(GDFT)on intraoperative fluid balance,postoperative morbidity,and mortality.Methods:This is a prospective randomized study,and 90 patients who underwent elective open gastrointestinal cancer surgery between April 2017 and May 2018 were included.Patients were randomized into 2 groups that received liberal fluid therapy(the LFT group,n=45)and goal-directed fluid therapy(the GDFT group,n=45).Patients’Colorectal Physiologic and Operative Severity Score for the enUmeration of Mortality and Morbidity(CR-POSSUM)physiological score,Charlson Comorbidity Index(CCI),perioperative vasopressor and inotrope use,postoperative AKIN classification,postoperative intensive care unit(ICU)hospitalization,hospital stay,and 30-day mortality were recorded.Results:The volume of crystalloid used perioperatively and the total volume of fluid were significantly lower in the GDFT group compared to the LFT group(P<0.05).CR-POSSUM physiological score and CCI were significantly higher in the GDFT group(P<0.05).Although perioperative vasopressor and inotrope use was significantly higher in the GDFT group(P<0.05),postoperative acute kidney injury development was not affected.Postoperative mortality was determined to be similar in both groups(P>0.05).Conclusion:Although GDFT was demonstrated to be a good alternative method to LFT in open gastrointestinal cancer surgery,and it can prevent perioperative fluid overload,and the postoperative results are comparable in the two groups.展开更多
Objective： To review the evolution of fluid therapy （IOFT） during liver transplantation （LTX） based on clinical experience in our institute over 7 years. Methods： All patient records （n= 130） of LTX from 1996 ...Objective： To review the evolution of fluid therapy （IOFT） during liver transplantation （LTX） based on clinical experience in our institute over 7 years. Methods： All patient records （n= 130） of LTX from 1996 to 2003 were examined. After excluding patients with co-morbidities 100 cases were found suitable for IOFT analysis. All patients had undergone LTX and follow-up under the same surgical team. Based on IOFT records we tried to identify distinct patterns of practice evolving over 7 years. Intraoperarive hemodynamics （IOHD） and long-term outcome records were examined. Results： Retrospectively, 3 types of IOFT were found. Group A （n= 18, period 1996-1997） received high amounts of crystallolds; group B （n=24, period 1998-2000） received high amounts of plasma and albumin; and group C （n=58, period 2001-2003） received lower amounts of albumin and plasma and recommended amounts of 6% hydroxyethyl starch 200/0. 5 （HES） and high amounts of vasopressors, lntraoperatively, group A exhibited the highest levels of central venous and pulmonary artery pressures in the neo-hepatic stage （P〈0.05）. Postoperatively, the patients in group C had the shortest time to extubation ; the values for group A,B,C were （15.8±11）, （17.3±10.2） and （7.98±3.2） h respectively（P〈0.05）. At the end of one-year follow-up, the patients in group C had the lowest mortality （group A, B, C were 27. 78%, 29. 17% and 6.25% respectively; P〈0. 05）. Conclusion： In our institute over the years the use of crystalloids, albumin and plasma during IOFT of LTX is gradually replaced to a large extent by HES. The improvements in IOHD and long term outcomes are likely to be related to improved surgical experience of our team. Nevertheless, the shift in IOFT practices might be associated with an beneficial effect on IOHD or long term outcome. Treatment with proper amount of liquid and vasoactive drugs may be a better method of fluid thera- py.展开更多
BACKGROUND Patients with rectal cancer undergoing radical resection often have poor post-operative recovery due to preoperative fasting and water deprivation and the removal of diseased tissue,and have a high risk of ...BACKGROUND Patients with rectal cancer undergoing radical resection often have poor post-operative recovery due to preoperative fasting and water deprivation and the removal of diseased tissue,and have a high risk of complications.Therefore,it is of great significance to apply appropriate rehydration regimens to patients un-dergoing radical resection of rectal cancer during the perioperative period to improve the postoperative outcomes of patients.AIM To analyze the effects of goal-directed fluid therapy(GDFT)with a preoperative glucose load regimen on postoperative recovery and complications in patients undergoing radical resection for rectal cancer.METHODS Patients with rectal cancer who underwent radical resection(n=184)between January 2021 and December 2023 at our hospital were randomly divided into either a control group or an observation group(n=92 in each group).Both groups received a preoperative glucose load regimen,and routine fluid replacement and GDFT were additionally implements in the control and observation groups,res-pectively.The operative conditions,blood levels of lactic acid and inflammatory markers,postoperative recovery,cognitive status,hemodynamic indicators,brain oxygen metabolism,and complication rates were compared between the groups.RESULTS The colloidal fluid dosage,total infusion,and urine volume,as well as time to first exhaust,time to food intake,and postoperative length of hospital stay,were lower in the observation group(P<0.05).No significant differences were observed between the two groups in terms of operation time,bleeding volume,crystalloid liquid consumption,time to tracheal extubation,complication rate,heart rate,or mean arterial pressure(P>0.05).Compared with the control group,in the ob-servation group the lactic acid level was lower immediately after the surgery(P<0.05);the Mini-Mental State Examination score was higher on postoperative day 3(P<0.05);the pulse pressure variability(PPV)was lower at 30 min after pneumoperitoneum(P<0.05),though the differences in the PPV of the two groups was not significant at the remaining time points(P>0.05);tumor necrosis factor-αand interleukin-6 levels were lower on postoperative day 3(P<0.05);and the left and right regional cerebral oxygen saturation was higher immediately after the surgery and 30 min after pneumoperitoneum(P<0.05).CONCLUSION GDFT combined with the preoperative glucose load regimen is a safe and effective treatment strategy for im-proving postoperative recovery and risk of complications in patients with rectal cancer undergoing radical re-section.展开更多
<strong>Objective:</strong><span style="font-family:;" "=""><span style="font-family:Verdana;"> To explore the effects of goal-directed fluid therapy (GDFT) o...<strong>Objective:</strong><span style="font-family:;" "=""><span style="font-family:Verdana;"> To explore the effects of goal-directed fluid therapy (GDFT) on lung function, cognitive function and inflammatory response in patients undergoing radical esophageal cancer surgery under one-lung ventilation. </span><b><span style="font-family:Verdana;">Methods:</span></b><span style="font-family:Verdana;"> Sixty-seven patients undergoing radical esophageal cancer surgery were divided into GDFT group</span></span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">(GDFT therapy) and control group</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">(conventional liquid therapy). The changes in patients</span><span style="font-family:Verdana;">’</span><span style="font-family:Verdana;"> pulmonary function,</span><span style="font-family:;" "=""> </span><span style="font-family:;" "=""><span style="font-family:Verdana;">cognitive function and inflammatory response were evaluated. </span><b><span style="font-family:Verdana;">Results:</span></b><span style="font-family:Verdana;"> Both alveolar-arterial oxygen partial pressure difference</span></span><span style="font-family:;" "=""> </span><span style="font-family:;" "=""><span style="font-family:Verdana;">[P(A-a)O</span><sub><span style="font-family:Verdana;">2</span></sub><span style="font-family:Verdana;">] and respiratory index</span></span><span style="font-family:;" "=""> </span><span style="font-family:;" "=""><span style="font-family:Verdana;">(RI) increased at one-lung ventilation for 30 minutes (T</span><sub><span style="font-family:Verdana;">2</span></sub><span style="font-family:Verdana;">) and decreased at one-lung ventilation for 60 minutes</span></span><span style="font-family:;" "=""> </span><span style="font-family:;" "=""><span style="font-family:Verdana;">(T</span><sub><span style="font-family:Verdana;">3</span></sub><span style="font-family:Verdana;">), and after surgery (T</span><sub><span style="font-family:Verdana;">4</span></sub><span style="font-family:Verdana;">) in the two groups, and the GDFT group </span></span><span style="font-family:Verdana;">was</span><span style="font-family:Verdana;"> lower than the control group (P</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;"><</span><span style="font-family:;" "=""> </span><span style="font-family:;" "=""><span style="font-family:Verdana;">0.05);theoxygenation index (OI) of the two groups decreased at T</span><sub><span style="font-family:Verdana;">2</span></sub><span style="font-family:Verdana;">, T</span><sub><span style="font-family:Verdana;">3</span></sub><span style="font-family:Verdana;">, and T</span><sub><span style="font-family:Verdana;">4</span></sub><span style="font-family:Verdana;"> compared with</span></span><span style="font-family:;" "=""> </span><span style="font-family:;" "=""><span style="font-family:Verdana;">that at T</span><sub><span style="font-family:Verdana;">1</span></sub><span style="font-family:Verdana;"> (before one-lung ventilation), and the GDFT group was higher than the control group (P</span></span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;"><</span><span style="font-family:;" "=""> </span><span style="font-family:;" "=""><span style="font-family:Verdana;">0.05). At T</span><sub><span style="font-family:Verdana;">4</span></sub><span style="font-family:Verdana;"> and T</span><sub><span style="font-family:Verdana;">5</span></sub><span style="font-family:Verdana;">, the tumor necrosis factor </span><i><span style="font-family:Verdana;">α</span></i><span style="font-family:Verdana;"> (TNF-</span><i><span style="font-family:Verdana;">α</span></i><span style="font-family:Verdana;">), interleukin 6 (IL-6), central nervous system specific protein (S100</span><i><span style="font-family:Verdana;">β</span></i><span style="font-family:Verdana;">), and neuron specific enolase (NSE) in the GDFT group were lower compared to the control group (P</span></span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;"><</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">0.05), while interleukin-10 (IL-10) was higher compared to the control group (P</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;"><</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">0.05);the incidence of perioperative neurocognitive disorder (PND) in the GDFT group was lower than that in the control group (P</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;"><</span><span style="font-family:;" "=""> </span><span style="font-family:;" "=""><span style="font-family:Verdana;">0.05). </span><b><span style="font-family:Verdana;">Conclusion:</span></b><span style="font-family:Verdana;"> GDFT can help prevent lung injury during radical esophageal cancer surgery under one-lung ventilation, reduce the body</span></span><span style="font-family:Verdana;">’</span><span style="font-family:Verdana;">s inflammatory response, and reduce the incidence of perioperative cognitive disorder to a certain extent.</span>展开更多
BACKGROUND Postoperative nausea-vomiting(PONV)occurs often after surgery performed under general anesthesia.Liberal fluid treatments are a low-cost and a low sideeffect alternative to pharmacological treatment in the ...BACKGROUND Postoperative nausea-vomiting(PONV)occurs often after surgery performed under general anesthesia.Liberal fluid treatments are a low-cost and a low sideeffect alternative to pharmacological treatment in the prevention of PONV.AIM To compare the effects of perioperative liberal and restrictive fluid therapy on PONV and recovery after laparoscopic cholecystectomy.METHODS A total of 160 patients were randomly allocated to two groups:Liberal fluid treatment group(group L),and restrictive fluid treatment group(group R).Three patients were excluded.Ringer’s lactate infusion was administered intravenously as follows:20 mL/kg/hour to group L,and 4 mL/kg/hour to group R.The primary outcomes were PONV incidence 24 hours postoperatively and the quality of recovery-15 scale at 24 hours postoperatively.RESULTS The incidence of PONV was significantly lower in group L(38.0%)compared with group R(70.5%)(relative risk:0.54,95%confidence interval:0.39-0.74,P<0.001).The quality of recovery-15 scale scores for overall satisfaction were significantly higher in group L compared with group R[137(135-141)vs 135(130-139),P=0.006].CONCLUSION Perioperative liberal fluid therapy reduced the incidence of PONV and improved the quality of postoperative recovery in patients undergoing laparoscopic cholecystectomy.展开更多
文摘Background:Isotonic crystalloids are recommended as the first choice for fluid therapy in acute pan-creatitis(AP),with normal saline(NS)and lactate Ringer’s(LR)used most often.Evidence based recom-mendations on the type of fluid are conflicting and generally come from small single-center randomized controlled trials(RCTs).We therefore conducted a systematic review and meta-analysis to compare the effect of balanced solutions(BS)versus NS on patient-centered clinical outcomes in AP.Methods:From four databases searched up to October 2024,we included only RCTs of adult patients with AP that compared the use of BS(including LR,acetate Ringer’s,etc.)with NS.The primary out-come was the disease advances from AP to moderately severe and severe AP(MSAP/SAP).Trial sequential analyses(TSA)were conducted to control for type-I and type-II errors and Grading of Recommendations Assessment,Development,and Evaluation(GRADE)was used to assess the quality of evidence.Results:Six RCTs were identified and included,involving 260 patients treated with BS and 298 patients with NS.Patients who received the BS had less MSAP/SAP[odds ratio(OR)=0.50,95%confidence in-terval(CI):0.29 to 0.85,P=0.01,I^(2)=0%;5 studies,299 patients],reduced the need of ICU admission(OR=0.60,95%CI:0.39 to 0.93,P=0.02,I^(2)=0%;5 studies,507 patients)and shorter length of hospital stay[mean difference(MD)=-0.88,95%CI:-1.48 to-0.28,P=0.004,I^(2)=0%;6 studies,558 patients;confirmed by TSA with high certainty]compared with those who received NS.The evidence for most of the clinical outcomes was rated as moderate to low due to the risk of bias,imprecision and inconsistency.Conclusions:BS,compared with NS,was associated with improved clinical outcomes in patients with AP.However,given the moderate to low quality of evidence for most of the outcomes assessed,further trials are warranted.
文摘Microbial infection is a principal etiological factor in pulp and periapical diseases,necessitating effective root canal therapy(RCT)for thorough decontamination of the root canal system.However,conventional mechanical and chemical preparation methods remain inadequate,often leaving significant portions of the canal uncleaned and contributing to persistent infection.The advent of erbium laser-assisted chemical preparation has demonstrated significant potential in enhancing root canal disinfection through advanced fluid dynamics mechanisms,particularly cavitation and photoacoustic streaming.This review explores the fundamental principles governing fluid dynamics in erbium laser-assisted irrigation,with a focus on primary and secondary cavitation effects.The interaction between erbium laser energy and water generates vapor bubbles that induce dynamic fluid movement,enhancing the penetration and distribution of irrigants deep within the root canal system.Key factors influencing fluid dynamics intensity,including laser parameters,working tip design,and water medium confinement,are critically analyzed.Furthermore,recent advancements such as Photon-Initiated Photoacoustic Streaming(PIPS),Photoacoustic Synchronized Transients(PHAST),and Shock Wave Enhanced Emission Photoacoustic Streaming(SWEEPS)are reviewed in the context of their ability to improve fluid motion and irrigation efficacy.While these laser-assisted techniques offer promising improvements over traditional methods,challenges remain in optimizing energy parameters and mitigating the constraints imposed by confined root canal environments.Future research should focus on refining fluid dynamics models and conducting clinical studies to validate the efficacy of these innovations.This review aims to provide a comprehensive overview of current developments in fluid dynamics research related to erbium laser-assisted chemical preparation,offering insights into its potential as an advanced modality for root canal disinfection.
基金Supported by the 2024 Hebei Medical Science Research Project,No.20241638Key Research and Development Program of Zhangjiakou City,No.2311041D.
文摘BACKGROUND An investigation is undertaken to assess the effects of permissive hypercapnia(PH)combined with goal-directed fluid therapy(GDFT)on postoperative recovery and psychological well-being among elderly patients undergoing laparoscopic surgical procedures.AIM To ascertain whether the combination of PH and GDFT improves clinical recovery indicators,reduces postoperative complications,and alleviates anxiety,depression,and inflammatory responses in this specific patient population.METHODS A total of 120 elderly patients who underwent laparoscopic surgery in our hospital from July 2023 to June 2024 were randomly allocated into two groups:A control group(n=60)and a study group(n=60).In the control group,conventional anesthesia ventilation and fluid management protocols were administered,while in the study group,PH(with intraoperative PaCO_(2) maintained between 45-55 mmHg)was combined with GDFT.Postoperative recovery indicators,including the time to first flatus,time to ambulation,and length of hospital stay,were compared between the groups.Additionally,complication rates,anxietydepression scores assessed via the Hospital Anxiety and Depression scale,and levels of inflammatory factors were analyzed to evaluate the outcomes.RESULTS When compared with the control group,the study group demonstrated significantly shorter time to first flatus[(48.3±6.2)hours vs(62.5±7.8)hours],time to ambulation[(28.4±4.2)hours vs(38.6±5.1)hours],and length of hospital stay[(5.2±1.1)days vs(7.4±1.3)days](P<0.05).A significantly lower postoperative complication rate was observed in the study group(8.3%vs 21.7%,P<0.05).Additionally,at 3 days postoperatively,significantly lower anxiety scores[(5.2±1.4)vs(7.8±1.6)]and depression scores[(4.8±1.2)vs(7.1±1.5)]were recorded in the study group compared to the control group(P<0.05);Furthermore,at 24 hours postoperatively,serum levels of interleukin-6,tumor necrosis factorα,and C-reactive protein were found to be significantly lower in the study group than in the control group(P<0.05).CONCLUSION Postoperative recovery is significantly expedited,postoperative complications are markedly reduced,anxietydepression status is substantially improved,and inflammatory response is notably diminished in elderly patients undergoing laparoscopic surgery when PH is combined with GDFT,thereby making it worthy of clinical application.
基金supported by the Chaozhou Municipal Health Bureau Scientific Research Project(No.2021021)。
文摘Background Continuous renal replacement therapy(CRRT)is frequently applied in critically ill patients with acute kidney injury who are vulnerable to cardiovascular complications.Differences in calcium management during CRRT may affect cardiac electrophysiology and hemodynamic stability,potentially influencing cardiovascular outcomes.Methods A total of 96 patients receiving CRRT were enrolled in this single-center study between September 2020 and September 2023.Patients were divided into two groups:those receiving calcium-containing replacement fluids(n=46)and those receiving calcium-free fluids(n=50).Clinical outcomes,including major adverse cardiovascular events(MACE),arrhythmias,hypotension,myocardial infarction,sudden cardiac arrest,intensive care units(ICU)stays,and hospital mortality,were compared between the two groups.Results The calcium-containing group had a significantly lower incidence of MACE(20%vs.32%,P<0.001)and arrhythmias(8%vs.17.3%,P=0.010)compared to the calcium-free group.ICU stays were also shorter in the calcium-containing group(11.6±8.8 days vs.16.6±7.6 days,P=0.004).Hospital mortality showed a trend toward being lower in the calciumcontaining group,though this was not statistically significant(0.6%vs.10.1%,P=0.063).No significant differences were observed in the incidence of hypotension,myocardial infarction,or sudden cardiac arrest.Conclusions Calcium-containing replacement fluids during CRRT were associated with improved clinical outcomes,including lower rates of MACE and arrhythmias,as well as shorter ICU stays.This simplified approach may be safer and more efficient,but larger studies are needed to confirm these findings and assess long-term outcomes.
文摘BACKGROUND Acute pancreatitis(AP)is a frequent gastrointestinal emergency characterized by inflammation.It has the potential to progress to organ failure.Fluid therapy plays a critical role in early AP management,mitigating hypovolemia-induced ischemia and systemic inflammatory response syndrome(SIRS).AIM To evaluate dextran 40+Ringer’s lactate solution(RLS)vs RLS alone for fluid therapy in mild to moderate AP.METHODS We conducted a single-center,single-blind,randomized controlled trial involving 108 patients with mild to moderate AP.Participants were randomized to receive either dextran 40+RLS(1:3 ratio)or RLS alone.All patients underwent standardized,goal-directed fluid therapy and were monitored for clinical response,inflammatory markers,and complications.The primary outcomes were reduction in C-reactive protein(CRP)and resolution of SIRS at 72 hours.Secondary outcomes included organ failure,intensive care unit admission,mortality,and length of hospital stay.RESULTS The dextran 40+RLS group demonstrated significantly lower CRP levels.No differences were observed in SIRS changes,fluid overload,refractory status mortality,local complications,or organ failure rates.Hospitalization tended to be shorter in the dextran 40+RLS group(5 days vs 6 days)although not to a statistically significant level(P=0.1).Adverse events were mild and comparable in both groups.CONCLUSION Dextran 40+RLS improved the early CRP response in patients with AP without added complications.Although medium-term outcomes were similar,early benefits support its use in initial management.
基金a grant from the Bureauof Science & Technology of Guangxi province(No.0342014).
文摘BACKGROUND: Although liver transplantation (LT) has made rapid progress, early pulmonary complications still occur. More attention should be paid to fluid therapy that may be an important factor leading to these complications. It is necessary to investigate the correlation between intraoperative and postoperative fluid therapy and early pulmonary complications after LT, then attempt to provide a reasonable fluid therapy in the perioperative period. METHODS: Sixty-two patients who had undergone Ff were enrolled and analyzed retrospectively. Based on early phase prognosis after LT, the 62 patients were divided into a non-pulmonary complication group and a pulmonary complication group. Twenty perioperative variables were analyzed in both groups to screen out several factors causing early pulmonary complications, then the parameters reflecting postoperative recovery were analyzed. RESULTS: The pulmonary complication group had 29 patients (46.77%), 3 (4.84%) of whom died during the perioperative period. Using monofactorial analysis for each variable, the two groups differed in the following variables: preoperative lung function, volume of intraoperative transfusion, volume of intraoperative bleeding, and volume of intraoperative net fluid retention and fluid balance (<=-500 ml) in >= 2 of the first 3 days after operation. Analysis of the relationship between multivariate factors and pulmonary complications after LT by logistic multivariate regression analysis showed that preoperative lung function, volume of intraoperative bleeding, and fluid balance (<=-500 ml) in >=-2 of the first 3 days after operation were influential factors. CONCLUSIONS: It is important to maintain fluid balance during the perioperative period of LT. If the hemodynamics are stable, appropriate negative fluid balance in the first 3 days after operation apparently decreases the incidence of early pulmonary complications after LT. These measures are associated with better postoperative recovery.
基金supported by the Department of Anesthesiologyand Pain MedicineUniversity of California Davis Health System+1 种基金SacramentoCA 95617 and NIH Grant(#UL1 TR000002)
文摘Intraoperative fluid management is pivotal to the outcome and success of surgery, especially in high-risk proce- dures. Empirical formula and invasive static monitoring have been traditionally used to guide intraoperative fluid management and assess volume status. With the awareness of the potential complications of invasive procedures and the poor reliability of these methods as indicators of volume status, we present a case scenario of a patient who underwent major abdominal surgery as an example to discuss how the use of minimally invasive dynamic monitoring may guide intraoperative fluid therapy.
文摘AIM: To investigate the effect of perioperative restricted fluid therapy on circulating CD4<sup>+</sup>/CD8<sup>+</sup> T lymphocyte ratio, percentage of regulatory T cells (Treg) and postoperative complications in patients with colorectal cancer.
基金Supported by Grants from the Bureau of Science and Technology of Guangxi Zhuang Autonomous Region,No.0342014
文摘AIM:To investigate the correlation between peri-operative fluid therapy and early-phase recovery after liver transplantation(LT) by retrospectively reviewing 102 consecutive recipients.METHODS:Based on whether or not the patients had pulmonary complications,the patients were categorized into non-pulmonary and pulmonary groups.Twentyeight peri-operative variables were analyzed in both groups to screen for the factors related to the occurrence of early pulmonary complications.RESULTS:The starting hemoglobin(Hb) value,an intra-operative transfusion > 100 mL/kg,and a fluid balance ≤-14 mL/kg on the first day and the second or third day post-operatively were significant factors for early pulmonary complications.The extubation time,time to initial passage of flatus,or intensive care unit length of stay were significantly prolonged in patients who had not received an intra-operative transfusion ≤ 100 mL/kg or a fluid balance ≤-14 mL/kg on the first day and the second or the third day post-operatively.Moreover,these patients had poorer results in arterial blood gas analysis.CONCLUSION:It is important to offer a precise and individualized fluid therapy during the peri-operative period to the patients undergoing LT for cirrhosis-associated hepatocellular carcinoma.
基金Supported by Canada Research Chair in Critical Care NephrologyClinical Investigator Award from Alberta Innovates-Health Solutions to Bagshaw MS
文摘Fluid therapy is perhaps the most common intervention received by acutely ill hospitalized patients; however, a number of critical questions on the efficacy and safety of the type and dose remain. In this review, recent insights derived from randomized trials in terms of fluid type, dose and toxicity are discussed. We contend that the prescription of fluid therapy is context-specific and that any fluid can be harmful if administered inappropriately. When contrasting ‘‘crystalloid vs colloid'', differences in efficacy are modest but differences in safety are significant. Differences in chloride load and strong ion difference across solutions appear to be clinically important. Phases of fluid therapy in acutely ill patients are recognized, including acute resuscitation, maintaining homeostasis, and recovery phases. Quantitative toxicity(fluid overload) is associated with adverse outcomes and can be mitigated when fluid therapy basedon functional hemodynamic parameters that predict volume responsiveness and minimization of non-essential fluid. Qualitative toxicity(fluid type), in particular for iatrogenic acute kidney injury and metabolic acidosis, remain a concern for synthetic colloids and isotonic saline, respectively. Physiologically balanced crystalloids may be the ‘‘default'' fluid for acutely ill patients and the role for colloids, in particular hydroxyethyl starch, is increasingly unclear. We contend the prescription of fluid therapy is analogous to the prescription of any drug used in critically ill patients.
基金supported by the National High Level Hospital Clinical Research Funding(2022-PUMCHB-119).
文摘Objective Although goal-directed fluid therapy(GDFT)has been proven to be effective in reducing the incidence of postoperative complications,the underlying mechanisms remain unknown.The aim of this study was to examine the mediating role of intraoperative hemodynamic lability in the association between GDFT and the incidence of postoperative complications.We further tested the role of this mediation effect using mean arterial pressure,a hemodynamic indicator.Methods This secondary analysis used the dataset of a completed nonrandomized controlled study to investigate the effect of GDFT on the incidence of postoperative complications in patients undergoing posterior spine arthrodesis.We used a simple mediation model to test whether there was a mediation effect of average real variability between the association of GDFT and postoperative complications.We conducted mediation analysis using the mediation package in R(version 3.1.2),based on 5,000 bootstrapped samples,adjusting for covariates.Results Among the 300 patients in the study,40%(120/300)developed postoperative complications within 30 days.GDFT was associated with fewer 30-day postoperative complications after adjustment for confounders(odds ratio:0.460,95%CI:0.278,0.761;P=0.003).The total effect of GDFT on postoperative complications was-0.18(95%CI:-0.28,-0.07;P<0.01).The average causal mediation effect was-0.08(95%CI:-0.15,-0.04;P<0.01).The average direct effect was-0.09(95%CI:-0.20,0.03;P=0.17).The proportion mediated was 49.9%(95%CI:18.3%,140.0%).Conclusions The intraoperative blood pressure lability mediates the relationship between GDFT and the incidence of postoperative complications.Future research is needed to clarify whether actively reducing intraoperative blood pressure lability can prevent postoperative complications.
文摘BACKGROUND Intraoperative fluid management is an important aspect of anesthesia mana-gement in gastrointestinal surgery.Intraoperative goal-directed fluid therapy(GDFT)is a method for optimizing a patient's physiological state by monitoring and regulating fluid input in real-time.AIM To evaluate the efficacy of intraoperative GDFT in patients under anesthesia for gastrointestinal surgery.METHODS This study utilized a retrospective comparative study design and included 60 patients who underwent gastrointestinal surgery at a hospital.The experimental group(GDFT group)and the control group,each comprising 30 patients,received intraoperative GDFT and traditional fluid management strategies,respectively.The effect of GDFT was evaluated by comparing postoperative recovery,com-plication rates,hospitalization time,and other indicators between the two patient groups.RESULTS Intraoperative blood loss in the experimental and control groups was 296.64±46.71 mL and 470.05±73.26 mL(P<0.001),and urine volume was 415.13±96.72 mL and 239.15±94.69 mL(P<0.001),respectively.The postoperative recovery time was 5.44±1.1 days for the experimental group compared to 7.59±1.45 days(P<0.001)for the control group.Hospitalization time for the experimental group was 10.87±2.36 days vs 13.65±3 days for the control group(P<0.001).The visual analogue scale scores of the experimental and control groups at 24 h and 48 h INTRODUCTION Gastrointestinal surgery is one of the most common procedures in the field of general surgery[1],involving the stomach,intestines,liver,pancreas,spleen,and other internal abdominal organs[2,3].With advancements in surgical technology and anesthesia methods,the safety and success rates of surgery have significantly improved[4,5].However,intraop-erative fluid management remains a critical challenge[6].Traditional fluid management strategies often rely on experience and basic physiological parameters,which may lead to excessive or insufficient fluid input,thereby affecting postoperative recovery and complication rates.Intraoperative goal-directed fluid therapy(GDFT)is an emerging fluid management strategy that dynamically adjusts fluid input volume by monitoring the patient's hemodynamic parameters in real-time to optimize the patient's physiological state[7,8].GDFT has shown superiority in many surgical fields;however,its application in gastrointestinal surgery requires further research and verification[9,10].The application of intraoperative GDFT in clinical settings has gradually increased in recent years[11,12].Studies have demonstrated that GDFT can optimize tissue perfusion and oxygenation by precisely controlling fluid input and reducing the occurrence of postoperative complications[13,14].For example,in cardiac and major vascular surgeries,GDFT significantly reduced the incidence of postoperative acute kidney injury and cardiovascular events[15,16].Similarly,in abdominal surgery,GDFT effectively reduced postoperative infections and expedited recovery[17].However,studies on the utilization of GDFT in gastrointestinal surgery are relatively limited and they are confounded by contradictory findings[18].Traditional fluid management strategies typically rely on estimating fluid input volume based on the patient's weight,preoperative status,and basic physiological parameters[19].However,this method lacks real-time dynamic adjustment,which may result in either insufficient or excessive fluid input,consequently affecting postoperative recovery.Insufficient fluid input can lead to hypovolemia and inadequate tissue perfusion,whereas excessive fluid input can cause tissue edema and postoperative complications,such as pulmonary edema and heart failure.GDFT involves dynamically adjusting fluid input volume by monitoring the patient's hemodynamic parameters in real-time,such as cardiac output,pulse pressure variability,and central venous pressure.Commonly used monitoring equipment include esophageal Doppler and pulse wave profile analyzers[20].These devices provide real-time hemo-dynamic data to assist anesthesiologists in tailoring fluid therapy to a patient's specific condition.Firstly,the patient's volume responsiveness is assessed by preloading fluid;secondly,fluid input volume is dynamically adjusted based on real-time monitoring data;finally,vasoactive and inotropic drugs are administered in combination to further optimize the patient’s hemodynamic status.Through personalized fluid management,GDFT can more accurately maintain intraop-erative hemodynamic stability and reduce complications[21].Gastrointestinal surgery involves procedures on multiple organs,often requiring prolonged operative times and extensive tissue trauma,which presents challenges for intraop-erative fluid management.Surgical procedures can lead to significant bleeding and fluid loss,requiring prompt and effective fluid replenishment.In addition,the slow recovery of gastrointestinal function after surgery and susceptibility to complications such as intestinal obstruction and delayed gastric emptying elevate the necessity for postoperative fluid management.
文摘Fifty dogs were inflicted with burn-blast combined injury and divided into 5 groups. All the experimental animals began to receive various amounts of fluid and sodium slat replacement 2 h after injury. Serum level of endogenous digitalis-like factor (EDLF
文摘Objective: It has been suggested that the use of hypotonic intravenous fluid (IVF) puts hospitalized children at a greater risk of developing hyponatremia in children with increased arginine vasopressin (AVP) production. To reduce its risk, the National Patient Safety Agency in UK issued alert 22 in 2007, of which recommendations were to use isotonic solutions for these children at risk of hyponatremia, instead of the previously most commonly used IVF (0.18% saline/ 4% dextrose) for maintenance fluid therapy. Recent observations, however, revealed that hypokalemia are also common in hospitalized patients who do not receive potassium in their IVF. This study was conducted to validate the potassium added IVF for the prevention of hospital-acquired hypokalemia in maintenance fluid therapy. Design: For maintenance fluid therapy, a commercially available IVF solution in Japan named as Solita-T2R (Na 84 mmol/L, K 20 mmol/L, Cl 66 mmol/L, glucose 3.2%) was infused for 41 sick children with a median age of 3.01 years. Its composition is close equivalent to 0.45% saline/5% dextrose (Na 77 mmol/L, K 0 mmol/L, Cl 77 mmol/L, dextrose 5%) except K content. The patients in states of AVP excess were excluded from the analysis. Results: Median serum potassium value did not drop significantly at a median interval of 48 hours (before IVF: 4.30 mmol/L, after IVF: 4.10 mmol/L, p > 0.05), whereas median serum sodium level significantly increased from 136.0 mmol/L to 139.0 mmol/L (p < 0.001). Conclusion: Potassium added (20 mmol/L) IVF solution reduces the risk of developing “hospital-acquired hypokalemia” in children who are not in states of AVP excess in maintenance fluid therapy. It is worthwhile to study prospectively in a larger number of sick children.
文摘Objective:To investigate the effects of perioperative goal-directed fluid therapy(GDFT)on intraoperative fluid balance,postoperative morbidity,and mortality.Methods:This is a prospective randomized study,and 90 patients who underwent elective open gastrointestinal cancer surgery between April 2017 and May 2018 were included.Patients were randomized into 2 groups that received liberal fluid therapy(the LFT group,n=45)and goal-directed fluid therapy(the GDFT group,n=45).Patients’Colorectal Physiologic and Operative Severity Score for the enUmeration of Mortality and Morbidity(CR-POSSUM)physiological score,Charlson Comorbidity Index(CCI),perioperative vasopressor and inotrope use,postoperative AKIN classification,postoperative intensive care unit(ICU)hospitalization,hospital stay,and 30-day mortality were recorded.Results:The volume of crystalloid used perioperatively and the total volume of fluid were significantly lower in the GDFT group compared to the LFT group(P<0.05).CR-POSSUM physiological score and CCI were significantly higher in the GDFT group(P<0.05).Although perioperative vasopressor and inotrope use was significantly higher in the GDFT group(P<0.05),postoperative acute kidney injury development was not affected.Postoperative mortality was determined to be similar in both groups(P>0.05).Conclusion:Although GDFT was demonstrated to be a good alternative method to LFT in open gastrointestinal cancer surgery,and it can prevent perioperative fluid overload,and the postoperative results are comparable in the two groups.
文摘Objective： To review the evolution of fluid therapy （IOFT） during liver transplantation （LTX） based on clinical experience in our institute over 7 years. Methods： All patient records （n= 130） of LTX from 1996 to 2003 were examined. After excluding patients with co-morbidities 100 cases were found suitable for IOFT analysis. All patients had undergone LTX and follow-up under the same surgical team. Based on IOFT records we tried to identify distinct patterns of practice evolving over 7 years. Intraoperarive hemodynamics （IOHD） and long-term outcome records were examined. Results： Retrospectively, 3 types of IOFT were found. Group A （n= 18, period 1996-1997） received high amounts of crystallolds; group B （n=24, period 1998-2000） received high amounts of plasma and albumin; and group C （n=58, period 2001-2003） received lower amounts of albumin and plasma and recommended amounts of 6% hydroxyethyl starch 200/0. 5 （HES） and high amounts of vasopressors, lntraoperatively, group A exhibited the highest levels of central venous and pulmonary artery pressures in the neo-hepatic stage （P〈0.05）. Postoperatively, the patients in group C had the shortest time to extubation ; the values for group A,B,C were （15.8±11）, （17.3±10.2） and （7.98±3.2） h respectively（P〈0.05）. At the end of one-year follow-up, the patients in group C had the lowest mortality （group A, B, C were 27. 78%, 29. 17% and 6.25% respectively; P〈0. 05）. Conclusion： In our institute over the years the use of crystalloids, albumin and plasma during IOFT of LTX is gradually replaced to a large extent by HES. The improvements in IOHD and long term outcomes are likely to be related to improved surgical experience of our team. Nevertheless, the shift in IOFT practices might be associated with an beneficial effect on IOHD or long term outcome. Treatment with proper amount of liquid and vasoactive drugs may be a better method of fluid thera- py.
文摘BACKGROUND Patients with rectal cancer undergoing radical resection often have poor post-operative recovery due to preoperative fasting and water deprivation and the removal of diseased tissue,and have a high risk of complications.Therefore,it is of great significance to apply appropriate rehydration regimens to patients un-dergoing radical resection of rectal cancer during the perioperative period to improve the postoperative outcomes of patients.AIM To analyze the effects of goal-directed fluid therapy(GDFT)with a preoperative glucose load regimen on postoperative recovery and complications in patients undergoing radical resection for rectal cancer.METHODS Patients with rectal cancer who underwent radical resection(n=184)between January 2021 and December 2023 at our hospital were randomly divided into either a control group or an observation group(n=92 in each group).Both groups received a preoperative glucose load regimen,and routine fluid replacement and GDFT were additionally implements in the control and observation groups,res-pectively.The operative conditions,blood levels of lactic acid and inflammatory markers,postoperative recovery,cognitive status,hemodynamic indicators,brain oxygen metabolism,and complication rates were compared between the groups.RESULTS The colloidal fluid dosage,total infusion,and urine volume,as well as time to first exhaust,time to food intake,and postoperative length of hospital stay,were lower in the observation group(P<0.05).No significant differences were observed between the two groups in terms of operation time,bleeding volume,crystalloid liquid consumption,time to tracheal extubation,complication rate,heart rate,or mean arterial pressure(P>0.05).Compared with the control group,in the ob-servation group the lactic acid level was lower immediately after the surgery(P<0.05);the Mini-Mental State Examination score was higher on postoperative day 3(P<0.05);the pulse pressure variability(PPV)was lower at 30 min after pneumoperitoneum(P<0.05),though the differences in the PPV of the two groups was not significant at the remaining time points(P>0.05);tumor necrosis factor-αand interleukin-6 levels were lower on postoperative day 3(P<0.05);and the left and right regional cerebral oxygen saturation was higher immediately after the surgery and 30 min after pneumoperitoneum(P<0.05).CONCLUSION GDFT combined with the preoperative glucose load regimen is a safe and effective treatment strategy for im-proving postoperative recovery and risk of complications in patients with rectal cancer undergoing radical re-section.
文摘<strong>Objective:</strong><span style="font-family:;" "=""><span style="font-family:Verdana;"> To explore the effects of goal-directed fluid therapy (GDFT) on lung function, cognitive function and inflammatory response in patients undergoing radical esophageal cancer surgery under one-lung ventilation. </span><b><span style="font-family:Verdana;">Methods:</span></b><span style="font-family:Verdana;"> Sixty-seven patients undergoing radical esophageal cancer surgery were divided into GDFT group</span></span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">(GDFT therapy) and control group</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">(conventional liquid therapy). The changes in patients</span><span style="font-family:Verdana;">’</span><span style="font-family:Verdana;"> pulmonary function,</span><span style="font-family:;" "=""> </span><span style="font-family:;" "=""><span style="font-family:Verdana;">cognitive function and inflammatory response were evaluated. </span><b><span style="font-family:Verdana;">Results:</span></b><span style="font-family:Verdana;"> Both alveolar-arterial oxygen partial pressure difference</span></span><span style="font-family:;" "=""> </span><span style="font-family:;" "=""><span style="font-family:Verdana;">[P(A-a)O</span><sub><span style="font-family:Verdana;">2</span></sub><span style="font-family:Verdana;">] and respiratory index</span></span><span style="font-family:;" "=""> </span><span style="font-family:;" "=""><span style="font-family:Verdana;">(RI) increased at one-lung ventilation for 30 minutes (T</span><sub><span style="font-family:Verdana;">2</span></sub><span style="font-family:Verdana;">) and decreased at one-lung ventilation for 60 minutes</span></span><span style="font-family:;" "=""> </span><span style="font-family:;" "=""><span style="font-family:Verdana;">(T</span><sub><span style="font-family:Verdana;">3</span></sub><span style="font-family:Verdana;">), and after surgery (T</span><sub><span style="font-family:Verdana;">4</span></sub><span style="font-family:Verdana;">) in the two groups, and the GDFT group </span></span><span style="font-family:Verdana;">was</span><span style="font-family:Verdana;"> lower than the control group (P</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;"><</span><span style="font-family:;" "=""> </span><span style="font-family:;" "=""><span style="font-family:Verdana;">0.05);theoxygenation index (OI) of the two groups decreased at T</span><sub><span style="font-family:Verdana;">2</span></sub><span style="font-family:Verdana;">, T</span><sub><span style="font-family:Verdana;">3</span></sub><span style="font-family:Verdana;">, and T</span><sub><span style="font-family:Verdana;">4</span></sub><span style="font-family:Verdana;"> compared with</span></span><span style="font-family:;" "=""> </span><span style="font-family:;" "=""><span style="font-family:Verdana;">that at T</span><sub><span style="font-family:Verdana;">1</span></sub><span style="font-family:Verdana;"> (before one-lung ventilation), and the GDFT group was higher than the control group (P</span></span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;"><</span><span style="font-family:;" "=""> </span><span style="font-family:;" "=""><span style="font-family:Verdana;">0.05). At T</span><sub><span style="font-family:Verdana;">4</span></sub><span style="font-family:Verdana;"> and T</span><sub><span style="font-family:Verdana;">5</span></sub><span style="font-family:Verdana;">, the tumor necrosis factor </span><i><span style="font-family:Verdana;">α</span></i><span style="font-family:Verdana;"> (TNF-</span><i><span style="font-family:Verdana;">α</span></i><span style="font-family:Verdana;">), interleukin 6 (IL-6), central nervous system specific protein (S100</span><i><span style="font-family:Verdana;">β</span></i><span style="font-family:Verdana;">), and neuron specific enolase (NSE) in the GDFT group were lower compared to the control group (P</span></span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;"><</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">0.05), while interleukin-10 (IL-10) was higher compared to the control group (P</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;"><</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">0.05);the incidence of perioperative neurocognitive disorder (PND) in the GDFT group was lower than that in the control group (P</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;"><</span><span style="font-family:;" "=""> </span><span style="font-family:;" "=""><span style="font-family:Verdana;">0.05). </span><b><span style="font-family:Verdana;">Conclusion:</span></b><span style="font-family:Verdana;"> GDFT can help prevent lung injury during radical esophageal cancer surgery under one-lung ventilation, reduce the body</span></span><span style="font-family:Verdana;">’</span><span style="font-family:Verdana;">s inflammatory response, and reduce the incidence of perioperative cognitive disorder to a certain extent.</span>
文摘BACKGROUND Postoperative nausea-vomiting(PONV)occurs often after surgery performed under general anesthesia.Liberal fluid treatments are a low-cost and a low sideeffect alternative to pharmacological treatment in the prevention of PONV.AIM To compare the effects of perioperative liberal and restrictive fluid therapy on PONV and recovery after laparoscopic cholecystectomy.METHODS A total of 160 patients were randomly allocated to two groups:Liberal fluid treatment group(group L),and restrictive fluid treatment group(group R).Three patients were excluded.Ringer’s lactate infusion was administered intravenously as follows:20 mL/kg/hour to group L,and 4 mL/kg/hour to group R.The primary outcomes were PONV incidence 24 hours postoperatively and the quality of recovery-15 scale at 24 hours postoperatively.RESULTS The incidence of PONV was significantly lower in group L(38.0%)compared with group R(70.5%)(relative risk:0.54,95%confidence interval:0.39-0.74,P<0.001).The quality of recovery-15 scale scores for overall satisfaction were significantly higher in group L compared with group R[137(135-141)vs 135(130-139),P=0.006].CONCLUSION Perioperative liberal fluid therapy reduced the incidence of PONV and improved the quality of postoperative recovery in patients undergoing laparoscopic cholecystectomy.
