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[Application of goal-oriented fluid replacement therapy in volume management of postpartum hemorrhage during cesarean section]
Yu Y, Zhang Y, Zhu X, Zhang C, Tong C, Zhao Y
Zhonghua wei zhong bing ji jiu yi xue. 2021;33(3):305-310
Abstract
OBJECTIVE To observe the effect of fluid therapy on volume and coagulation function in patients with severe postpartum hemorrhage during cesarean section of placenta accreta under the guidance of inferior vena cava diameter (IVCD) and inferior vena cava collapse index (IVC-CI). METHODS A prospective randomized controlled study was conducted in 60 pregnant women with severe postpartum hemorrhage (blood loss ≥ 1 000 mL) who were hospitalized for delivery or referred for delivery in the Peking University Third Hospital from December 2018 to July 2019. The patients were divided into routine fluid replacement group and goal-oriented fluid resuscitation group (goal-oriented fluid replacement therapy was given) according to the different ways of fluid replacement. The hemodynamics, blood gas analysis, coagulation function, total fluid replacement, urine volume, prognosis, intraoperative vasoactive drugs utilization rate and postoperative adverse events were recorded before skin incision, after the fetus delivered, postpartum hemorrhage and at the end of operation, and the differences of these indices between the two groups were compared. RESULTS (1) Hemodynamics: the heart rate (HR) of the two groups were reached the peak during postpartum hemorrhage, but there was no significant difference in HR at each time point between the two groups. The mean arterial pressure (MAP) was decreased at first and then increased in both groups, and reached the trough at postpartum hemorrhage, but the MAP in the goal-oriented fluid resuscitation group was significantly higher than that in the routine fluid replacement group [mmHg (1 mmHg = 0.133 kPa): 75.6±10.7 vs. 69.2±8.9, P < 0.05]. In the goal-oriented fluid resuscitation group, the central venous pressure (CVP) was increased slightly after the fetus delivered and then stabilized, while in the routine fluid replacement group, the CVP was increased at first and then decreased, and reached the peak in postpartum hemorrhage. During postpartum hemorrhage, CVP in the goal-oriented fluid resuscitation group was significantly lower than that in the routine fluid replacement group [cmH(2)O (1 cmH(2)O = 0.098 kPa): 9.5±3.9 vs. 11.4±3.4, P < 0.05]. (2) Arterial blood gas: partial pressure of oxygen (PaO(2)) and partial pressure of carbon dioxide (PaCO(2)) in arterial blood at the end of operation in both groups were higher than those in postpartum hemorrhage. There was no significant difference in PaO(2) at the end of operation between the goal-oriented fluid resuscitation group and routine fluid replacement group (mmHg: 189.3±100.5 vs. 240.2±126.3, P > 0.05). The PaCO(2) in the goal-oriented fluid resuscitation group was significantly lower than that in the routine fluid replacement group (mmHg: 34.6±4.6 vs. 36.8±4.1, P < 0.05). The lactic acid (Lac) at the end of operation of the goal-oriented fluid resuscitation group was significantly lower than that of the routine fluid replacement group (mmol/L: 2.2±0.6 vs. 2.6±1.1, P < 0.05). (3) Liquid intake and output volume: the total infusion volume, crystal fluid infusion volume and suspended red blood cell infusion volume in the goal-oriented fluid resuscitation group were significantly less than those in the routine fluid replacement group [total infusion volume (mL): 3 385.9±1 144.1 vs. 4 448.3±1 194.4, crystal infusion volume (mL): 2 635.6±789.7 vs. 3 160.0±860.3, suspended red blood cell input volume (mL): 695.6±366.2 vs. 911.1±284.7, all P < 0.05], and the utilization rate of vasoactive drugs in the goal-oriented fluid resuscitation group was decreased significantly during operation [13.3% (4/30) vs. 60.0% (18/30), P < 0.05]. The amount of bleeding in the goal-oriented fluid resuscitation group was also significantly less than that in the routine fluid replacement group (mL: 1 451.7±373.8 vs. 1 725.9±372.8, P < 0.05), but there was no significant difference in urine volume between the goal-oriented fluid resuscitation group and the routine fluid replacement group (mL: 369.0±262.7 vs. 485.0±286.8, P > 0.05). (4) Coagulation function: at the end of operation, the prothrombin time (PT) in the goal-oriented fluid resuscitation group was significantly shorter than that in the routine fluid replacement group (s: 10.9±0.6 vs. 11.2±0.6), and the fibrinogen (Fib) in the goal-oriented fluid resuscitation group was significantly higher than that in the routine fluid replacement group (g/L: 3.7±0.5 vs. 2.9±0.8), and the differences were statistically significant (both P < 0.05). (5) Prognostic index: compared with the routine fluid replacement group, the proportion of patients transferred to intensive care unit (ICU) at the end of operation in the goal-oriented fluid resuscitation group was significantly lower [16.7% (5/30) vs. 66.7% (20/30), P < 0.05], and ICU length-of-stay was significantly shorter [hours: 0 (0, 24) vs. 24 (0, 24), P < 0.05], but there was no significant difference in the incidence of disseminated intravascular coagulation (DIC), acute renal injury (AKI) or hysterectomy between the goal-oriented fluid resuscitation group and the routine fluid replacement group [the incidence of DIC: 0% (0/30) vs. 6.7% (2/30), the incidence of AKI: 0% (0/30) vs. 3.3% (1/30), the hysterectomy rate: 10.0% (3/30) vs. 26.7% (8/30), all P > 0.05]. CONCLUSIONS Fluid resuscitation guided by IVC-CI can effectively reduce the volume of blood and fluid transfusion and blood loss in patients with severe postpartum hemorrhage and improve their blood coagulation function.
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Effects of low-temperature plasma treatment on pulmonary function in children with obstructive sleep apnea-hypopnea syndrome
Wang X, Liu Y, Tang G, Wang H, Zhao Y
Irish journal of medical science. 2019
Abstract
BACKGROUND Obstructive sleep apnea-hypopnea syndrome (OSAHS) is a common sleep-related respiratory disease. Despite reports of low-temperature plasma radiofrequency ablation of tonsils and adenoids for the treatment of OSAHS, the effects on lung function and quality of life are unclear. AIMS This study aims to explore the effects of low-temperature plasma treatment on pulmonary function in children with OSAHS. METHODS A total of 110 children with OSAHS were included in this prospective study. Low-temperature plasma radiofrequency treatment and routine surgical treatment were performed in group A and group B, respectively. Maximal voluntary ventilation (MVV), forced vital capacity (FVC), and total lung capacity (TLC) were measured. OSA-18 survey was used to evaluate the quality of life 1 year after operation. RESULTS Group A had significantly higher effective treatment rate (P < 0.05) and lower operative period, bleeding volume, visual analog score, pseudomembrane detachment time, and time required to feed after operation than group B (all P < 0.001). There were no significant difference in the incidence of postoperative complications between the groups and MVV, FVC, and TLC between the groups before and after operation (all P > 0.05), and the above indexes in both groups were significantly increased after operation (all P < 0.05). OSA-18 scores in group A were significantly lower than group B after operation (P < 0.001). CONCLUSIONS Low-temperature plasma technique performed in OSAHS children has a good clinical effect, which can reduce the operation time, intraoperative blood loss, postoperative pain, pseudomembrane detachment time, hospitalization time, and improve pulmonary function and quality of life.
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Autologous Platelet-Rich Gel for the Treatment of Diabetic Sinus Tract Wounds: A Clinical Study
Xie J, Fang Y, Zhao Y, Cao D, Lv Y
The Journal of surgical research. 2019
Abstract
BACKGROUND The aim of this study was to evaluate the efficacy of autologous platelet-rich gel (APG) in the treatment of deep sinus tract wounds from diabetic ulcers. METHODS Forty-eight patients with diabetic ulcers were randomly classified into two groups: an APG treatment group (25 patients) and a conventional wound dressing control group (23 patients). The sinus tract closure times, ulcer healing rates, hospitalization times, and hospitalization expenses of the two groups were compared. RESULTS There were no significant differences in the basic data and wound conditions between the two groups. The cure (healed wound) rates were 96% and 87% for the APG group and control group, respectively. During the first 4 wk, the sinus tract closure rate for the APG group was significantly higher than that for the control group. However, there was no significant difference in the sinus tract healing between the two groups at the end of the 8th wk. For the APG group and the control group, the average hospital stays were 19.36 +/- 7.239 d and 48.13 +/- 11.721 d, respectively, and the total hospitalization expenses were 2.48 +/- 0.45 ten thousand yuan and 5.63 +/- 1.35 ten thousand yuan (P < 0.05), respectively. These differences were statistically significant. CONCLUSIONS When compared with conventional wound dressings, APG can accelerate the healing of deep sinus tract wounds associated with diabetic ulcers.
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Effect of eltrombopag on platelet response and safety results in Chinese adults with chronic ITP - primary result of a phase III study
Yang R, Hou M, Li J, Jin J, Huang M, Yu Z, Xu X, Zhang X, Du X, Niu T, et al
Blood. 2014;124((21)): Abstract No. 1464
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Retrograde autologous priming of the cardiopulmonary bypass circuit reduces blood transfusion in small adults: a prospective, randomized trial
Hou X, Yang F, Liu R, Yang J, Zhao Y, Wan C, Ni H, Gong Q, Dong P
European Journal of Anaesthesiology. 2009;26((12):):1061-6.
Abstract
BACKGROUND AND OBJECTIVE Extreme haemodilution occurring with cardiopulmonary bypass imposes a primary risk factor for blood transfusion in small adult cardiac surgical patients. Priming of the cardiopulmonary bypass circuit with patients' own blood [retrograde autologous priming (RAP)] is a technique used to limit haemodilution and reduce transfusion requirements. We designed this study to evaluate the effects of RAP on reducing perioperative blood transfusion in small adults. METHODS One hundred and twenty patients with a body surface area of less than 1. 5 m undergoing first-time, nonemergency cardiac surgery were randomized to either the standard priming group or the RAP group. All patients followed strict transfusion criteria. Homologous transfusion, haematocrit, plasma colloid osmotic pressure and postoperative clinical outcomes were evaluated perioperatively. RESULTS Patient characteristics and operative parameters were equal for patients in both groups. With autologous priming, a mean volume of 614. 8 +/- 138. 8 ml of priming solution was replaced with autologous blood. This allowed a significantly higher haematocrit value during cardiopulmonary bypass (P < 0. 05). Red blood cell transfusion was necessary in 83. 3% of patients of the standard priming group on pump, whereas only 26. 7% of patients of the RAP group required transfusion (P < 0. 01). The overall transfusion rate of the RAP group was significantly less than that in the standard priming group during the hospitalization (90. 0 vs. 50. 0%, P < 0. 01). Amongst patients who received transfusion on pump, the number of homologous units of packed red blood cells was less in the RAP group than that in the standard priming group intraoperatively and perioperatively (0. 94 +/- 0. 32 vs. 1. 48 +/- 0. 68 units, P = 0. 03; 1. 24 +/- 0. 54 vs. 1. 69 +/- 0. 69 units, P = 0. 15). Ten minutes after aortic cross-clamp, colloid osmotic pressure was reduced by 39. 7 +/- 2. 8% in the standard priming group and by 28. 6 +/- 3. 2% in the RAP group (P < 0. 05). Clinical outcomes were similar with respect to pulmonary, renal and hepatic function, length of ICU stay and hospital stay. CONCLUSION RAP resulted in a significant decrease in intraoperative haemodilution and conserved the use of blood. This technique should be considered for patients with a small body surface area (<1. 5 m) undergoing open heart surgery.
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Evaluation of the quality of processed blood salvaged during craniotomy
Liang H, Zhao Y, Wang D, Wang B
Surgical Neurology. 2009;71((1):):74-80.
Abstract
BACKGROUND The objective of the study was to evaluate the quality of salvaged blood retrieved during craniotomy after the processing by autotransfusion devices and to compare the processing effects of 2 autotransfusion devices: ZITI-2000 (Jingjing Medical Equipment Limited, Beijing, PR China) and BRAT 2 (Cobe Cardiovascular Inc, Division of Sorin Biomedica Arvada Co, Arvada, Colo). METHODS Twenty-four patients scheduled for elective craniotomy were randomly allocated into 2 groups, and 1 of the 2 autotransfusion devices (ZITI-2000 and BRAT 2) was used for each group. The blood samples were collected, washed, and tested for select blood components. The efficacy of centrifugation and washing was assessed by determining the ER of PLTs, WBCs, K+, and fHb. The morphology of the washed erythrocytes and the 2-week-old PRBCs was evaluated by means of SEM. RESULTS Extensive hemolysis was observed in the collected blood of both ZITI-2000 and BRAT 2 groups, with fHb being 464. 8 +/- 111. 6 and 459. 0 +/- 91. 6 mg/dL, respectively. The ERs of PLTs, WBCs, K+, and fHb were >35%, >80%, >90%, and >90%, respectively. Although some shape-changed red cells were observed in the washed blood, discocytes were the dominant form in both groups, with the percentages of discocytes being 58. 0% +/- 8. 0% and 59. 7% +/- 8. 3%, respectively. A greater number of shape-changed red cells were found in 2-week-old PRBCs (P < . 01). CONCLUSION For craniotomies, the quality of salvaged blood processed by both devices (ZITI-2000 and BRAT 2) is equally satisfactory. Although extensive hemolysis is noted in the salvaged blood, IBS can be effectively and safely used.