儿科肝移植围手术期液体管理:系统回顾

IF 0.6 Q3 ANESTHESIOLOGY
Raihanita Zahra, Andi Ade Wijaya Ramlan, Christopher Kapuangan, Rahendra Rahendra, Komang Ayu Ferdiana, Arif Hari Martono Marsaban, Aries Perdana, Nathasha Brigitta Selene
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引用次数: 0

摘要

由于术后并发症和血流动力学不稳定的风险,围手术期液体管理仍然是儿科肝移植(LT)的一个挑战。有关液体管理和输血对小儿肝移植患者死亡率和发病率影响的专门研究十分有限。本系统性综述总结了有关儿科LT患者围手术期液体管理及其临床结果的证据。所有以英语发表的评估小儿LT患者围手术期输液管理的主要研究均符合条件。检索了PubMed、EBSCOHost、Embase、Proquest和Google Scholar数据库,检索时间从开始到2023年12月19日。采用乔安娜-布里格斯研究所(Joanna-Briggs Institute)的核对表对偏倚风险进行了评估。对结果进行了叙述性综合。本综述纳入了五项质量良好-优秀的回顾性队列研究。两项研究评估了术中输液情况,一项研究比较了术后体液平衡(FB)与预后,两项研究比较了大量输液与非大量输液。与正常生理盐水相比,静脉注射乳酸林格氏液(LR)的死亡率更高,但与大量输液(MT)无关。住院时间较长与大量输血、头 72 小时内 FB 阳性率大于 20% 以及术中血液制品总用量较多有关。术中输液量越大,血栓风险越高。此外,术中MT和lR输注分别与30天移植物丢失和移植物功能障碍的风险增加有关。输液管理可能会影响小儿LT受者的预后。这些研究结果突出表明,有必要开展更多研究,以探索接受LT治疗的儿童的最佳液体管理和评估策略。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Perioperative Fluid Management in Paediatric Liver Transplantation: A Systematic Review.

Perioperative fluid management remains a challenging aspect of paediatric liver transplantation (LT) because of the risk of postoperative complications and haemodynamic instability. Limited research has specifically investigated the impact of fluid management and transfusion on mortality and morbidity in pediatric LT patients. This systematic review summarizes the evidence regarding perioperative fluid management and its clinical outcomes in paediatric LT patients. All primary studies published in English evaluating perioperative fluid management in paediatric LT patients were eligible. PubMed, EBSCOHost, Embase, Proquest, and Google Scholar databases were searched from inception to December 19, 2023. Risks of bias were assessed using the Joanna-Briggs Institute checklist. The results were synthesized narratively. Five retrospective cohort studies of good-excellent quality were included in this review. Two studies evaluated intraoperative fluid administration, one study compared postoperative fluid balance (FB) with outcomes, and two studies compared massive versus non-massive transfusion. A higher mortality rate was associated with intravenous lactated ringer's (LR) than with normal saline, but not with massive transfusion (MT). Longer hospital stays were correlated with MT, >20% positive FB in the first 72 hours, and greater total intraoperative blood product administration. Higher intraoperative fluid administration was associated with a greater thrombotic risk. Additionally, intraoperative MT and lR infusion were associated with an increased risk of 30-day graft loss and graft dysfunction, respectively. Fluid management may impact the outcomes of paediatric LT recipients. These findings underscore the need for more studies to explore the best fluid management and evaluation strategies for children undergoing LT.

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