Abstract:

Objective To investigate the role of ultrasound-based volume assessment in perioperative fluid management of liver transplant recipients. Methods A total of 106 end-stage liver disease patients who underwent liver transplantation at the Liver Transplantation Center， China-Japan Friendship Hospital， between September 2020 and April 2024 were enrolled. Using a historical control design， patients were divided into two groups based on whether postoperative ultrasonic volume indices were monitored. Cumulative intensive care unit （ICU） fluid balance and length of ICU stay were compared between the groups. Results Baseline characteristics （sex， age， BMI， etiology） were comparable. Pre-transplant MELD-Na scores （23 ± 10 vs. 22 ± 9，P ＝ 0.654） and APACHE II scores on ICU admission 〔19（5）vs. 19（3），P ＝ 0.525〕 were not statistically different. Patients in the ultrasound-monitored group （n ＝ 53）had longer operative times 〔10.0（3.1） h vs 9.4（2.3） h，P ＝ 0.016〕 and greater intraoperative fluid balance 〔（5341± 3447） ml vs.（1728 ± 2519） ml，P ＜ 0.001） than the non-monitored group. However， cumulative ICU fluid balance 〔-863（4600）ml vs. -48（2786）ml ，P ＝ 0.029〕 and daily fluid balance〔-276（1123）ml vs. -12（811）ml， P ＝ 0.017〕 were lower in the ultrasound-monitored group. Mechanical ventilation duration， ICU length of stay， and totalhospital stay did not differ between groups. Subgroup analyses showed no clear association in ultrasonic volume indices （lung ultrasound score， E-wave velocity， and renal venous congestion grading） for three consecutive days after the patients were transferred to the general ward and the incidence of AKI within 48 h post-operation was comparable（P ＞0.05）. Conclusion Ultrasound-assisted perioperative volume assessment in liver transplant recipients can mitigate fluid overload but does not shorten hospital stay. 

Key words: Liver transplantation； , Critical care ultrasound； , Fluid therapy； , Volume management

摘要：

目的 探讨基于超声的容量评估对于肝移植术后患者液体管理的作用。方法 纳入 2020 年 9 月至 2024 年 4 月在中日友好医院肝移植中心行肝移植手术的终末期肝病患者共 106 例，通过历史对照，依据是否进行术后超声容量指标监测将其分为两组，比较两组患者术后重症监护病房（intensive care unit，ICU）累积液体平衡情况和 ICU 住院时长的差异。结果 两组患者基线情况（性别、年龄、BMI、病因）一致，移植时MELD-Na 评分〔（23±10）比（22±9），P ＝ 0.654〕和移植后入 ICU 时的 APACHEII 评分〔19（5）比 19（3），P ＝ 0.525〕亦无统计学差异。53 例行超声容量监测的患者手术时间〔10.0（3.1）h 比 9.4（2.3）h，P ＝ 0.016〕和术中液体平衡情况〔（5341±3447）ml 比（1728±2519） ml，P ＜ 0.001〕大于非超声监测组。而 ICU 累积液体平衡情况〔-863（4600）ml 比 -48（2786）ml，P ＝ 0.029〕和日均液体平衡情况〔-276（1123）ml 比 -12（811）ml，P＝0.017〕小于非超声监测组。两组患者的机械通气时间、ICU住院日和总住院时间无统计学差异。亚组分析发现，转回普通病房连续 3 d 日的超声容量监测指标（肺超评分、E 峰和肾脏静脉回流评级）与术后48 h 内 AKI 的发生率无明确相关性（P ＞ 0.05）。结论 超声辅助的肝移植患者围手术期液体评估能够改善液体过度治疗，但不能缩短住院时间。

关键词:

肝移植 , 重症超声 , 液体治疗 , 容量管理