Alternatives to albumin administration in hepatocellular carcinoma patients undergoing hepatectomy： an open, randomized clinical trial of efficacy and safety  

作　　者：YANG Jian WANG Wen-tao YAN Lü-nan XU Ming-qing YANG Jia-yin 

机构地区：[1]Division of Liver-Transplantation, West China Hospital, West China Medical School of Sichuan University, Chengdu, Sichuan 610041, China

出　　处：《Chinese Medical Journal》2011年第10期1458-1464,共7页中华医学杂志（英文版）

摘　　要：Background The value of artificial colloids in treating patients with liver disease is controversial. The effects of intravascular volume replacement regimens on liver function secondary to alteration of the postoperative inflammatory response are not known. In this study, we evaluated the effects of different volume replacement regimens in hepatocellular carcinoma patients undergoing hepatectomy to clarify whether albumin administration can be replaced by other volume replacement products.Methods Ninety consecutive hepatocellular carcinoma patients scheduled for hepatectomy were prospectively randomized to receive 20% human albumin （HA）, 6% hydroxyethyl starch （HES） or lactated Ringer＇s solution （LR） for postoperative volume replacement. Hemodynamic, liver function and inflammatory response parameters were recorded on postoperative days one, three, and five throughout the investigation period.Results Significantly less volume was required in the HA and the HES groups. Although patients in all groups had similar baseline values, the plasma osmolality was significantly higher in the HA and HES groups. Total bilirubin （TB）, alanine aminotransferase （ALT）, and aspartate aminotransferase （AST） increased from baseline in all groups, and did not differ significantly between groups. C-reactive protein （CRP） was significantly lower in the HES group compared with the other groups.Conclusions In hepatocellular carcinoma patients undergoing hepatectomy, HA can be replaced by HES or LR in well selected patients. Hemodynamic stability, liver function, and postoperative clinical outcomes could be equivalently achieved in the HES group; also, HES may exert more favorable effects on the acute phase response. （Registered in the Chinese Clinical Trial Registry, ChiCTR-TRC-10000790）Background The value of artificial colloids in treating patients with liver disease is controversial. The effects of intravascular volume replacement regimens on liver function secondary to alteration of the postoperative inflammatory response are not known. In this study, we evaluated the effects of different volume replacement regimens in hepatocellular carcinoma patients undergoing hepatectomy to clarify whether albumin administration can be replaced by other volume replacement products.Methods Ninety consecutive hepatocellular carcinoma patients scheduled for hepatectomy were prospectively randomized to receive 20% human albumin （HA）, 6% hydroxyethyl starch （HES） or lactated Ringer＇s solution （LR） for postoperative volume replacement. Hemodynamic, liver function and inflammatory response parameters were recorded on postoperative days one, three, and five throughout the investigation period.Results Significantly less volume was required in the HA and the HES groups. Although patients in all groups had similar baseline values, the plasma osmolality was significantly higher in the HA and HES groups. Total bilirubin （TB）, alanine aminotransferase （ALT）, and aspartate aminotransferase （AST） increased from baseline in all groups, and did not differ significantly between groups. C-reactive protein （CRP） was significantly lower in the HES group compared with the other groups.Conclusions In hepatocellular carcinoma patients undergoing hepatectomy, HA can be replaced by HES or LR in well selected patients. Hemodynamic stability, liver function, and postoperative clinical outcomes could be equivalently achieved in the HES group; also, HES may exert more favorable effects on the acute phase response. （Registered in the Chinese Clinical Trial Registry, ChiCTR-TRC-10000790）

关 键 词：artificial colloids HEPATECTOMY hepatocellular carcinoma inflammatory response volume replacement 

分 类 号：TQ464.56[化学工程—制药化工] S858.31[农业科学—临床兽医学]