The Influence Of Human Serum Albumin And Hydroxyethyl Starch On Pulmonary Complications In The Early Stage After Liver Transplantation

Objective To discuss the relationship between application of Human Serum Albumin(HSA)or Hydroxyethyl Starch(HES)and pulmonary complications in the early stage after liver transplantation,and to provide the basis for reasonable fluid therapy during liver transplantation.Methods The clinical data of 60 cases of liver transplantation recipients from Organ Transplant Center in the Affiliated Hospital of Qingdao University between April 2014 to January 2016 were retrospectively analyzed.Inclusion Criteria:The primary criteria for end-stage cirrhosis,aged 40 to 60 years,body weight 55 ~ 75 kg,preoperative MELD score of 10 to 30 minutes,Child-Pugh score of 6 to 12 minutes,the American Association of Anesthesiologists Graded Ⅱ ~ Ⅳ level.Exclusion criteria: preoperative pulmonary disease,preoperative inhalation of air oxygen partial pressure less than 60 mm Hg,serum albumin <26 g / L,preoperative and intraoperative acute infection,left heart failure,gastrointestinal bleeding,cerebrovascular disease,a large number of blood transfusion or other active diseases,the process of surgery there are serious arrhythmia,intraoperative bleeding,severe fluctuations in blood pressure may cause the body to increase the inflammatory response to the situation.All cases were successful operation,surgery into the intensive care unit,routine mechanical ventilation,to antibiotics anti-infection,immunosuppressive agents anti-rejection and symptomatic supportive treatment.According to intraoperative fluid infusion were divided into HSA group and HES group.Observe two groups of recipients preoperative(T1),no stage liver(T2),a new liver(T3),24 h after surgery(T4),48 h after surgery(T5)pulmonary artery pressure,pulmonary capillary wedge pressure,pulmonary vascular resistance,pulmonary dynamic compliance,oxygenation index,inflammatory factors(IL-6,TNF-alpha,IL-10)changes,and postoperative mechanical ventilation time,ICU stay time,the incidence of pulmonary complications including pulmonary infection and acute lung injury.Results Two groups of 60 patients in general conditions including age,body mass index,Results Two groups of 60 patients in general conditions including age,body mass index,preoperative Child-Pugh score,preoperative hemoglobin,preoperative PCO2,preoperative oxygenation index and operation time,injection of red blood cell transfusion during operation,infusion of plasma volume,intraoperative blood loss,the total amount,the total was not statistically significant the amount of general difference(P > 0.05).Pulmonary artery pressure in HSA group was significantly lower than that of HES group at T4 and T5,respectively(t=-7.016,-7.374;P all< 0.05);Pulmonary capillary wedge pressure in HSA group from T2 to T5 was significantly lower than that of HES group,respectively(t=-7.526,-7.050,-6.213,-6.158;P all < 0.05);Pulmonary dynamic compliance in HSA group was higher than that of HES group at T2 and T3,the difference was statistically significant,respectively(t=4.832,5.041;P all< 0.05).Two groups of patients pulmonary vascular resistance and oxygenation index were not statistically significant in the T1 to T5(P>0.05).Plasma IL-6 in HSA group was lower than that of HES group at T5 respectively(t=-5.452;P< 0.05),and plasma TNF-α in HSA group was lower than that of HES group at T3,T4 and T5,respectively(t=-4.724,-3.815,-2.719;P < 0.05),However,plasma IL-10 in HSA group was higher than that of HES group at T5,respectively(t=2.060,P < 0.05).Mechanical ventilation time,ICU time,the incidence of pulmonary infection and acute lung injury in HSA group were lower than that of HES group,respectively(t=-2.088,3.738,X~2=4.02,4.02,;P all< 0.05).Conclusion In the fields of improving lung function,alleviating inflammation injury of pulmonary and reducing lung complications in liver transplantation,application of HSA may be better than HES.Significance This study was to investigate the effect of Human Albumin and hydroxyethyl starch on early lung after liver transplantation,and further to guide rational fluid replacement during liver transplantation.