During hepatectomy, surgeons often prefer to restrict fluid intake, believing that this can lower central venous pressure (CVP) and reduce intraoperative blood loss. However, fluid restriction may lead to inadequate perfusion of vital organs and even contribute to postoperative organ dysfunction, such as acute kidney injury (AKI). Therefore, this study aims to compare the effects of restrictive versus liberal fluid therapy on major complications following hepatectomy.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
PREVENTION
Masking
TRIPLE
Enrollment
90
Fluid infusion is restricted at 2 ml·kg- 1·h- 1 from the moment the patient arrive in the operating room to immediately after the liver lesions are removed
6 ml·kg- 1·h- 1 of hydroxyethyl starch solution is infused before anesthesia
Nitroglycerin is infused from start of anesthesia to immediately after the liver lesions are removed.The starting infusion rates of nitroglycerin is 0.5 μg·kg- 1·min- 1 . If the speed of administration requires adjustment, nitroglycerin is added or decreased by 0.1 μg·kg- 1·min- 1.
incidence of acute kidney injury
Postoperative acute kidney injury (AKI) was diagnosed and staged according to the Kidney Disease: Improving Global Outcomes (KDIGO) Clinical Practice Guideline for Acute Kidney Injury (2012). AKI was defined as the presence of any of the following criteria within 7 days after surgery: an increase in serum creatinine by ≥ 0.3 mg/dL (≥ 26.5 μmol/L) within 48 hours; an increase in serum creatinine to ≥ 1.5 times baseline, which is known or presumed to have occurred within the prior 7 days; or urine volume \< 0.5 mL/kg/h for 6 consecutive hours. Baseline serum creatinine was defined as the most recent preoperative value available within 3 months prior to surgery.
Time frame: from end of surgery to 7 days after surgery
Severity of acute kidney injury
AKI severity was further classified into three stages: stage 1 was defined as serum creatinine 1.5-1.9 times baseline or an increase of ≥ 0.3 mg/dL (≥ 26.5 μmol/L), or urine output \< 0.5 mL/kg/h for 6-12 hours; stage 2 as serum creatinine 2.0-2.9 times baseline, or urine output \< 0.5 mL/kg/h for ≥ 12 hours; and stage 3 as serum creatinine 3.0 times baseline, or an increase in serum creatinine to ≥ 4.0 mg/dL (≥ 353.6 μmol/L), or initiation of renal replacement therapy, or urine output \< 0.3 mL/kg/h for ≥ 24 hours, or anuria for ≥ 12 hours
Time frame: from end of surgery to discharge from hospital, at an average of 7 days
number of patients with post-hepatectomy liver failure
Time frame: from end of surgery to discharge from hospital, at an average of 7 days
number of patients with major cardiac complications
heart failure, myocardial ischemia and new on-set arrythmia
Time frame: from end of surgery to discharge from hospital, at an average of 7 days
volume of blood loss
The method for calculating blood loss is the volume in the suction canister plus the estimated amount of blood on the gauze
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Time frame: from start of surgery to end of surgery, at an average of 3 hours
numerical rating scale of surgeon's satisfaction to the surgical field
0 is extremely unsatisfied, 10 is extremely satisfied
Time frame: at the end of the surgery
control of central venous pressure during resection
0, uncontrolled central venous pressure (CVP), defined as the target CVP of \< 5 cmH₂O was achieved for at least 75% of the resection period; 1, defined as the target CVP of \< 5 cmH₂O was achieved for 50% -75% of the resection period; 1, defined as the target CVP of \< 5 cmH₂O was achieved for less than 50% of the resection period
Time frame: from start of resection to end of removal of the liver lesions ,at an average of 2 hours
dose of norepinephrine
Time frame: from start of surgery to end of surgery, at an average of 3 hours
frequency of hypotension
hypotension is defined as mean arterial pressure less than 60 mmHg
Time frame: from start of surgery to end of surgery, at an average of 3 hours
arterial lactate level
Time frame: upon completion of surgery，that is, end of incision suture，at an average of 3 hours after anesthesia induction
arterial lactate level
Time frame: When the liver lesions are removed，at an average of 2 hours after anesthesia induction
surgical field bleeding score
0=no bleeding; 1=minor bleeding, no aspiration required; 2=minor bleeding, aspiration required; 3 = minor bleeding, frequent aspiration required ; 4 = moderate bleeding, visible only aspiration; 5 = severe bleeding, frequent aspiration required, very hard to perform surgery
Time frame: at the end of the surgery, ，at an average of 3 hours after anesthesia induction