肝脏手术和输液策略对肾素活性、醛固酮和抗利尿激素水平的影响：GALILEO 试验的二次分析

IF 2.7 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Hpb Pub Date : 2024-10-01 DOI:10.1016/j.hpb.2024.06.005

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引用次数: 0

摘要

肝脏手术是否会导致 RAAS 活性和抗利尿激素（ADH）水平升高，进而导致液体积聚，目前尚不清楚。此外，围手术期输液策略是否会改变这种影响也不得而知。这是对一项随机对照试验进行的预先计划的事后分析，该试验比较了肝脏手术患者的限制性输液策略（= 20）和自由输液策略（= 20）。本次研究的主要结果是麻醉诱导后和肝脏切除术后激素水平的差异。液体超负荷的定义是体重增加≥10%。肾素活性（6 [2.1-15.5] vs. 12 [4.6-33.5]）和ADH水平（6.0 [1.7-16.3] vs. 3.8 [1.6-14.7]）在切除前后没有显著差异。但是，切除术后醛固酮水平明显升高（0.30 [0.17-0.49] vs. 0.69 [0.31-1.21] ）。肾素活性和醛固酮水平在各组之间没有差异。限制性策略组的 ADH 水平明显更高（1.6 [1.1-2.1] vs 5.9 [3.8-16.0]）。体液超负荷和无体液超负荷患者的激素水平没有差异。肝脏手术后醛固酮水平升高，但肾素活性和ADH水平没有升高。限制性组的 ADH 水平更高。术后体液超负荷与 RAAS 活性或 ADH 水平无关。

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The effect of liver surgery and fluid strategy on renin activity and aldosterone and anti-diuretic hormone levels: a secondary analysis of the GALILEO trial

Background

It is unknown whether liver surgery leads to increased RAAS activity and anti-diuretic hormone (ADH) levels and subsequent fluid accumulation. Furthermore, it is unknown whether the peri-operative fluid strategy changes this effect.

Methods

This is a pre-planned post hoc analysis of a randomised controlled trial which compared restrictive (n = 20) versus liberal fluid strategy (n = 20) in patients undergoing liver surgery. Primary outcomes for the current study were the difference in hormone levels after anaesthesia induction and after liver resection. Fluid overload was defined as a ≥10% increase in weight.

Results

Renin activity (6 [2.1–15.5] vs. 12 [4.6–33.5]) and ADH levels (6.0 [1.7–16.3] vs. 3.8 [1.6–14.7]) did not differ significantly before and after resection. However, aldosterone levels were significantly higher after resection (0.30 [0.17–0.49] vs. 0.69 [0.31–1.21] ). Renin activity and aldosterone levels did not differ between the groups. ADH was significantly higher in the restrictive strategy group (1.6 [1.1–2.1] vs 5.9 [3.8–16.0]). No differences in hormone levels were found in patients with and without fluid overload.

Discussion

Aldosterone levels increased after liver surgery but renin activity and ADH levels did not. ADH levels were higher in the restrictive group. Development of post-operative fluid overload was not associated with RAAS activity or ADH levels.

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来源期刊

Hpb GASTROENTEROLOGY & HEPATOLOGY-SURGERY

CiteScore

5.60

自引率

3.40%

发文量

244

审稿时长

57 days

期刊介绍： HPB is an international forum for clinical, scientific and educational communication. Twelve issues a year bring the reader leading articles, expert reviews, original articles, images, editorials, and reader correspondence encompassing all aspects of benign and malignant hepatobiliary disease and its management. HPB features relevant aspects of clinical and translational research and practice. Specific areas of interest include HPB diseases encountered globally by clinical practitioners in this specialist field of gastrointestinal surgery. The journal addresses the challenges faced in the management of cancer involving the liver, biliary system and pancreas. While surgical oncology represents a large part of HPB practice, submission of manuscripts relating to liver and pancreas transplantation, the treatment of benign conditions such as acute and chronic pancreatitis, and those relating to hepatobiliary infection and inflammation are also welcomed. There will be a focus on developing a multidisciplinary approach to diagnosis and treatment with endoscopic and laparoscopic approaches, radiological interventions and surgical techniques being strongly represented. HPB welcomes submission of manuscripts in all these areas and in scientific focused research that has clear clinical relevance to HPB surgical practice. HPB aims to help its readers - surgeons, physicians, radiologists and basic scientists - to develop their knowledge and practice. HPB will be of interest to specialists involved in the management of hepatobiliary and pancreatic disease however will also inform those working in related fields. Abstracted and Indexed in: MEDLINE® EMBASE PubMed Science Citation Index Expanded Academic Search (EBSCO) HPB is owned by the International Hepato-Pancreato-Biliary Association (IHPBA) and is also the official Journal of the American Hepato-Pancreato-Biliary Association (AHPBA), the Asian-Pacific Hepato Pancreatic Biliary Association (A-PHPBA) and the European-African Hepato-Pancreatic Biliary Association (E-AHPBA).