The Observe Of Perioperative Plasma Colloid Osmotic Pressure Of Patients Undergoing Liver Transplantation

Objective (1)To investigate the colloid osmotic pressure of the liquid duringstandard orthotopic liver transplantation(SOLT)without anhepatic veno-venousbypass in our hospital.(2) To investigate the changes of plasma colloid osmoticpressure during standard orthotopic liver transplantation(SOLT)without anhepaticveno-venous bypass. (3) To observe the influences of plasma colloid osmoticpressure after infusing 4ï¼…human serum albumin or hydroxyethyl starch 130/0.4sodium chloride injection(6ï¼…) during standard orthotopic livertransplantation(SOLT)without anhepatic veno-venous bypass. Methods (1)Randomselected 10 shares of each kind of the liquid used perioperative, including MultipleElectrolytes injection, polygeline injection, hydroxyethyl starch 130/0.4 sodiumchloride injection(6ï¼…), fresh-frozen plasma.concentrate red blood cell, 20ï¼…humanserum albumin,4ï¼…human serum albumin and 5ï¼…sodium bicarbonate injection. Oneman determined with the same ONKOMETER BMT923 colloid osmotic pressureradiomate made in Germany.(2) Thirty OLT for end-stage liver disease wereperformed under general anesthesia. Plasma colloid osmotic pressure ;plasma totalosmotic pressure and plasma albumin protein level were measured before punctingulnar vein(T₀), when begining operation (T₁),60min(T₂) in before anhepatic phase,cross-clamping of the portal vein(T₃), 30 min(T₄) in anhepatic phase, unclamping ofportal vein (T₅),60min in reperfused phase(T₆) and when suturing peritoneum(T₇). (3)Selected 10 patients without hypoproteinemia were randomly allocated to receivingintravenous infusion of 4ï¼…human serum albumin(â… ) and hydroxyethyl starch130/0.4 sodium chloride injection(6ï¼…)(â…¡), were performed under general anesthesia.Plasma colloid osmotic pressure and plasma albumin protein level were measuredbefore puncting ulnar vein(T₀), when infusing 30 min (T₁), infusing 60min(T₂), afterinfusing 30min(T₃)and after infusing 60min(T₄). Results (1)Compared with thenormal value of plasma colloid osmotic pressure.The hydroxyethyl starch 130/0.4sodium chloride injection (6ï¼…)and 20ï¼…human serum albumin was high colloidosmotic pressure liquid (P＜0.05). The fresh-frozen plasma and the polygelineinjection's colloid osmotic pressure was equal to plasma colloid osmotic pressure(P＞0.05). The concentrate red blood cell and 4ï¼…human serum albumin was low colloidosmotic pressure liquid. The Multiple Electrolytes injection and 5ï¼…sodiumbicarbonate injection was zero colloid osmotic pressure liquid.(2) Measured with T₀the plasma colloid osmotic pressure was stepped up from(T₂)(P＜0.05).andmaintained in high levels(T₄-T₅) (P＜0.01), descended in (T₆) but still higher than (T₀)(P＜0.05). Measured with fore-period (T₂) was higher than (T₁) (P＜0.05), (T₇)waslower than (T₆) (P＜0.01). The plasma albumin protein level was measured with(T₀),from (T₂)was stepped up(P＜0.05), and maintained high levels in (T₄), descended in(T₆-T₇) but still higher than (T₀) (P＜0.05). Measured with fore-period (T₂) washigher than (T₁)(P＜0.01). Measured with T₀ the plasma total osmotic pressure wasstepped up from (T₄) (P＜0.01). Measured with fore-period (T₃) was higher than(T₂)(P＜0.05), (T₄) was higher than(T₃) (P＜0.01), (T₆) was higher than(T₅) (P＜0.01). Thechanges of plasma albumin protein level and the Changes of plasma colloid osmotic pressure was positive straight line correlation. (r=0.842, P＜0.05)(3) The transfusevolume dose was (4239±615)ml in groupâ… and was (4340±586) ml in groupâ…¡. Ingroupâ… the plasma colloid osmotic pressure was descended at (T₁)(P＜0.05),andrecovered at (T₂), was higher than (T₁) (P＜0.05).In groupâ…¡the plasma colloidosmotic pressure was stepped up at (T₂)(P＜0.05). And was different at (T₁)(P＜0.05)and (T₂)(P＜0.01) between two group. The plasma albumin protein level wasstepped up at (T₁) (P＜0.05)in groupâ… . Compared with (T₁) and (T₀) the plasmaalbumin protein level was lower (P＜0.05) at (T₂) in groupâ…¡. And was different at (T₁)(P＜0.05)and (T₂, T₃, T₄)(P＜0.01) between two group. Conclusion (1)The resultshows that use fresh-frozen plasma, the polygeline injection can maintain normalplasma colloid osmotic pressure; use hydroxyethyl starch 130/0.4 sodium chlorideinjection (6ï¼…)and 20ï¼…human serum albumin can raise plasma colloid osmoticpressure;use the concentrate red blood cell and 4ï¼…human serum albumin and theMultiple Electrolytes injection and 5ï¼…sodium bicarbonate injection can lower plasmacolloid osmotic pressure.The fresh-frozen plasma's plasma colloid osmotic pressureis. the most stabilized, which of 4ï¼…human serum albumin is the least stabilized..(2)The patients' complication is pleural fluid, ascites, hypopreteinemia,hyponatremia indifferent degree before standard orthotopic liver transplantation. So the plasma totalosmotic pressure and plasma colloid osmotic pressure is lower before operation.Before anhepatic phase the plasma total osmotic pressure is not marked change, theplasma albumin protein level and plasma colloid osmotic pressure descend in earlybecause of anesthesia induction and use great liquid supply lead to hemodilution,andstep up to normal because of use great fresh-frozen plasma, concentrate red blood celland human serum albumin. During anhepatic phase the plasma albumin protein leveland plasma colloid osmotic pressure is maintain in normal,and the total osmoticpressure step up because of use great liquid contain sodium.During the reperfusedphase the plasma albumin protein level and plasma colloid osmotic pressure isdescend tendency but maintain in normal level because of openning inferior caval andvein returned blood volume raised,great liquid infusion. The observe seem to havestraight line correlation between plasma albumin protein level and plasma colloidosmotic pressure. According to this correlation we can inject human serum albuminbasis on plasma colloid osmotic pressure.(3) The plasma colloid osmotic pressure isdescend in short time and recover soon. maintain in normal for a long time wheninfusing 4ï¼…human serum albumin except infusing other blood products. Infuse 4ï¼…human serum albumin can maintain the plasma albumin protein level in normal, butcan't raise the level. Infuse the hydroxyethyl starch 130/0.4 sodium chlorideinjection(6ï¼…) can raise the plasma colloid osmotic pressure and cut down the plasmaalbumin protein level except infusing other blood products.