The Clinical Application Of Ringer's Malate Solution In Perioperative Hepatic Ischemia Protection

BackgroundLiver cancer is one of the most common malignancies in the world,with more than 650,000 people dying of liver cancer globally each year.There is a 123% increase in mortality from 1900.China accounts for about half of the world's cancer deaths,about 55 percent.In 2015 alone,more than 400,000 people in China died of liver cancer.The treatment of hepatocellular carcinoma is mainly surgical treatment,and chemoradiotherapy is not sensitive to liver cancer.Radical resection of liver cancer is the most effective treatment for hepatocellular carcinoma,and the cure rate of early hepatocellular carcinoma can reach 80%.However,it is a difficult clinical problem to reduce liver ischemia and reperfusion injury.In recent years,animal experiments proved that malic acid with circulatory collapse resistance and reduce the shock,the function of organ dysfunction,but also has anti liver cells and the role of myocardial cell oxidative stress,prompt malic acid to regulate the metabolism in biological activity plays an important role.More importantly,studies have shown that the use of Ringer's malate solution in the rat model of hemorrhagic shock can reduce liver damage.ObjectivesThis study uses different crystalloid solution to compare hemodynamics,internal environment,liver reserve function,hepatorenal biochemical function after operation and health economics after operation.MethodFrom October 2016 to October 2018,a randomized,controlled prospective clinical trial was conducted for patients who underwent hepatectomy in Changzheng hospital.All patients signed consent of admission and collected general information,including gender,age,body mass index and ASA classification.In operation,we recorded the time of the hepatic portal triad clamping,the number of hepatotomy,the bleeding volume,transfusion and infusion volume.50 patients were divided into two groups: 1.Ringer's laclate solution group(RL group,N= 25);2.Ringer' s malate solution group(RM group,N=25).Analysis of two major groups: after induction(T1),the moment of the hepatic portal triad clamping(T2),portal triad regain(T3),portal triad regain 40 min(T4)hemodynamics(mean arterial pressure and central venous pressure)and arterial blood gas analysis,including pH value,concentration of potassium,sodium,chloride,calcium,blood glucose,lactic acid;T1 and T4 liver function reserve status ICG PDR and R1 5.Liver and kidney biochemical indicators before operation(T0),1 day after surgery(T5),3 days after surgery(T6),including hospitalization and expenses.SPSS 23.0 statistical software was used for analysis,and P < 0.05 was considered statistically significant.Results1.Baseline demographic dataThere was no statistical difference between two groups in baseline characteristics including age,gender,BMI,ASA classification,operative time,blocking time,bleeding amount,transfusion volume,infusion volume,and number of hepatectomy(P>0.05).2.HemodynamicsThere was no statistical difference between two groups in hemodynamics including MAP and CVP in the time of T1,T2,T3 and T4(P>0.05).3.Blood gas analysis and change of liver function reserveThere was a statistically significance of pH value(T3:7.35±0.06vs7.35±0.04,P=0.001;T4:7.39±0.04vs7.37±0.05,P=0.048)arterial blood sugar(T3:12.86±2.64vs9.50±1.78,P<0.001;T4:11.00±2.14vs8.31±1.33,P<0.001)and artery blood lactate(T3:3.20±0.55vs2.09±0.57,P<0.001;T4:2.63±0.63vs1.44±0.45,P<0.001)in T3 and T4.But there was no statistical difference between two groups on concentration of sodium,potassium,chloride,calcium in the time of T1,T3 and T4(P>0.05).There was no statistically significant difference between the two groups of ICG PDR and R15 at the time T1 and T4,and the ICG PDR decreased significantly [RL:(18.73±1.97vs13.48±2.79,P<0.001);RM:(19.64±2.47vs14.62±2.74,P<0.001)],R15 significantly increased[RL:(7.06±1.51vs12.02±2.24,P<0.001);RM:(6.26±1.91vs10.53±3.40,P<0.001)] in T4 time compared with T1.4.Health economics and postoperative hepatic and renal functionThere was a statistical difference between AST and ALT in the two groups after one day of surgery(AST:414.32±213.60vs304.52±152.15,P=0.042;ALT:443.88±239.53 vs 305.32±190.46,P=0.029).The function of liver and kidney were not statistically significant the third day after surgery(P>0.05).There was no significant difference between the two groups in health economics(P>0.05).ConclusionThe use of Ringer's malate solution in liver surgery can keep the internal environment stable and reduce postoperative liver injury.