Effect of intermittent pringle manipulation on serum potassium concentration during laparoscopic hepatectomy: a self-controlled study protocol

Yan Weng, Ziqi Shang, Yan Wang, Xiaojuan Liu, Yuling Tang, Hua Zhang, Chunmei Wu, Wenjie Mao, Qing Zhong
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Abstract

Background Intermittent Pringle Manipulation (IPM) is among the most common methods used for controlling blood loss during hepatectomy. Ischaemia–reperfusion injury has also been associated with IPM. Ischaemic injury exposes the liver cells to hypoxia, adenosine triphosphate depletion, pH changes, and cellular metabolic stress, all of which can lead to cell damage and death. Reperfusion injury is caused by microcirculatory dysfunction, hypoxia, oxidative stress, and apoptosis. The pathophysiological mechanism of ischaemia-reperfusion injury is hyperkalaemia. Hyperkalaemia is closely related to the electrophysiological activity of the myocardium. Acute hyperkalaemia is associated with life-threatening ventricular arrhythmia and sudden cardiac arrest. Therefore, it is necessary to observe changes in patient serum potassium concentrations during IPM to provide a reference for developing a secure anaesthesia management approach. Methods and analysis This was a single-centre, open, non-interventional, self-controlled study. All eligible consecutive patients were recruited from a regional medical centre and scheduled for elective hepatectomy. There was no control group; all participants were continuously enrolled from 1 September 2023 to 31 August 2024. The primary outcome was the perioperative serum potassium concentration during IPM. Secondary outcomes included perioperative electrocardiogram changes, lactic acid status, postoperative serum potassium concentration, alanine amine transferase, and aspartate amine transferase peaks, adverse events, serious adverse events, and postoperative hospital stay. These parameters were statistically compared. Subgroup analysis will be performed according to liver disease type and duration of IPM. Discussion Our finding will provide a reference for developing a secure anaesthesia management approach for anesthesiologists. Ethics and dissemination The Biomedical Ethics Review Committee of the People’s Hospital of Jianyang City approved the study protocol (ethics reference: JY202383). All relevant ethical guidelines were followed in this study. The findings will be disseminated in peer-reviewed journals, publicly available reports to be published online, and academic conferences.
腹腔镜肝切除术中间歇性普林格尔操作对血清钾浓度的影响:一项自控研究方案
背景间歇性普林格尔手法(IPM)是肝切除术中控制失血最常用的方法之一。缺血再灌注损伤也与 IPM 有关。缺血损伤使肝细胞面临缺氧、三磷酸腺苷耗竭、pH 值变化和细胞代谢压力,所有这些都会导致细胞损伤和死亡。再灌注损伤是由微循环功能障碍、缺氧、氧化应激和细胞凋亡引起的。缺血再灌注损伤的病理生理机制是高钾血症。高钾血症与心肌的电生理活动密切相关。急性高钾血症与危及生命的室性心律失常和心脏骤停有关。因此,有必要观察 IPM 期间患者血清钾浓度的变化,为制定安全的麻醉管理方法提供参考。所有符合条件的连续患者都是从一个地区医疗中心招募而来,计划进行择期肝切除术。该研究不设对照组;所有参与者均在 2023 年 9 月 1 日至 2024 年 8 月 31 日期间连续注册。主要结果是 IPM 期间围手术期血清钾浓度。次要结果包括围手术期心电图变化、乳酸状态、术后血清钾浓度、丙氨酸氨基转移酶和天门冬氨酸氨基转移酶峰值、不良事件、严重不良事件和术后住院时间。对这些参数进行统计比较。讨论我们的研究结果将为麻醉医生制定安全的麻醉管理方法提供参考。伦理与传播建阳市人民医院生物医学伦理审查委员会批准了本研究方案(伦理编号:JY202383)。本研究遵循了所有相关的伦理准则。研究结果将在同行评审期刊、网上公开发表的报告和学术会议上传播。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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