Predictive value of glucose transporter type 4 for intensive care unit acquired weakness in liver transplantation recipients / 中华器官移植杂志

Objective:To seek the biomarkers of diagnostic value for an early postoperative onset of intensive care unit acquired weakness(ICUAW)in liver transplant(LT)recipients.Methods:Between September 2017 and August 2019, A total of 62 consecutive allogeneic orthotopic LT liver transplantation recipients at The First People's Hospital of Kunming between September 2017 and August 2019 are prospectively reviewedenrolled in this study. Upon After entering ICU, blood samples are assayed taken for adenosine 5'-monophosphate-activated protein kinase alpha(AMPK-α)、and glucose transporter type 4(GLUT-4)test. Clinical and bBiochemical specimens are collected. When transplant recipients are during awake and cooperative hours. Their muscle strength is recordedexamined. The score table of Medical Research Council(MRC)is utilized sed as the diagnostic standard of ICUAW. And ICUAW is diagnosed with < 48 points. Based on this, 62 subjects are divided into two groups of ICUAW group(17 cases)and non-ICUAW group (45 cases). The age, sex, mechanical ventilation time, ICU hospitalization time, partial blood oxygen pressure, systolic blood pressure, central venous pressure(CRP), blood glucose, total bilirubin, alanine aminotransferase(ALT), aspartate aminotransferase(AST), γ- Glutamyl transpeptidase(γ- GGT), blood urea nitrogen, blood creatinine and levels of AMPK-α and GLUT-4 are compared between patients in ICUAW group and non-ICUAW two groups. and levels of AMPK-α and GLUT-4 were compared between patients in ICUAW group and non-ICUAW two groups. The powers of AMPK-α And and GLUT-4 in predicting ICUAW was were evaluated by receiver operating characteristic curve(ROC)and area under the curve(AUC). Differences with P<0.05 is deemed as significant. Results:ICUAW is diagnosed in 17/62(27.42%)LT recipients. ICUAW patients had longer mechanical ventilation time(27 vs. 10h, P<0.05)and extended ICU hospitalization time(4 vs. 3d, P<0.05). No significant inter-group difference existed in AMPK-α(1.01±2.43 vs. 1.74±4.24 units/ml, 95% CI: -2.92~1.45, P>0.05). And the expression of GLUT-4 declined in ICUAW patients(137.86±127.87 vs. 419.15±267.68 ng/L, 95% CI: -417.13~-145.45, P<0.05). GLUT-4 ROC curve hint at some negative predictive value for the occurrence of ICUAW. ROC curve area was 0.88 and SE 0.05( P<0.05, 95% CI: 0.78~0.98). Conclusions:ICUAW patients have longer mechanical ventilation time and extended ICU hospitalization time. Monitoring GLUT-4 offers some predictive value for ICUAW in LT recipients. Elevated GLUT-4 is associated with a low probability of ICUAW.

Fluid management and risk factors of intra-abdominal hypertension secondary to postpartum hemorrhage / 中华围产医学杂志

Objective To investigate fluid management and risk factors of intra-abdominal hypertension (IAH) after postpartum hemorrhage.Methods Clinical data of 64 patients of postpartum hemorrhage who were admitted to Intensive Care Unit (ICU) of the First People's Hospital of Kunming from January 2013 to January 2015 were collected.The patients were divided into IAH group and non-IAH group based on intra-abdominal pressure on admission to ICU.Diuresis or dialysis were offered to patients whose output exceeded 1 000 ml of their input after hospitalization.The background information,including maternal age,existence of pre-eclampsia and whether hysterectomy and transcatheter arterial embolization were performed,intra-abdominal pressure,liver and renal function and length of stay in hospital between the two groups were compared.The intra-abdominal pressure and liver and renal function before and 24 h after negative fluid administration of all subjects were compared as well.Independent-samples t test,paired-samples t test,Chisquare test and logistic regression analysis were applied for statistics.Results Among all of the 64 patients,15(23,4％) presented with IAH on admission,25 (39.1％) were complicated with preeclampsia,one (1.6％) had the uterus removed,and 16 (25.0％) had transcatheter arterial embolization performed.Within 12 h before admission,the average blood loss of the 64 women was (4 022± 1 275) ml,crystal solution input was (8 894±2 597) ml,colloidal fluid input was (343 ± 87) ml,blood products input was (1 370± 346) ml,total fluid input was (10 607± 2 825) ml,total fluid output was (5 176±2 334) ml,average fluid input per hour was (884±235) ml and average urinary production per hour was (431 ±195) ml.Logistic regression analysis showed that pre-eclampsia (OR=5.30,95％CI:1.15-24.45),average fluid input per hour ＞ 1 000 ml (OR=5.34,95％CI:1.14-24.92) and average urinary production per hour ≤ 200 ml (＞200 ml,OR=0.17,95％CI:0.05-0.58) were risk factors of IAH.The non-IAH group showed shorter length of stay in ICU [(3.33± 1.84) vs (8.73 ±9.77) d] and shorter length of stay in hospital [(10.29±3.96) vs (18.13±9.88) d] than IAH group (t=-3.71 and-4.55,both P＜0.05).After 24 hours negative fluid administration,the intra-abdominal pressure [(6.67 ± 4.61) vs (8.47 ± 5.85) mmHg (1 mmHg=0.133 kPa),t=7.76],total serum bilirubin level [(14.31±14.91) vs (20.96 ± 37.56) μ mool/L,t=2.02],blood urea nitrogen level [(6.49±5.18) vs (7.57±7.07) mmol/L,t=2.72] and creatinine level [(105.57±81.66) vs (140.61 ± 126.14) μmol/L,t=5.33] were all significantly decreased comparing with before negative fluid administration,but the serum albumin level rised up [(24.45 ± 4.80) vs (21.35 ±5.69) g/L,t=-4.47].Conclusions Pre-eclampsia,massive fluids input and too little output per hour in patients complicated with postpartum hemorrhage were risk factors of IAH.IAH is harmful to liver and kidney,and makes the length of stay in hospital longer.However,negative fluid administration could decrease the intraabdominal pressure and improve the function of liver and kidney.

Relationship between postoperative intra-abdominal hypertension and fluid management during liver transplantation / 中华器官移植杂志

Objective To study the correlation between fluid management during liver transplantation and postoperative intra-abdorninal hypertension (IAH),and the correlation between intra-abdominal pressure and hemodynamics during liver transplantation.Method From Sep.2008 to Sep.2014,95 cases were admitted to ICU following liver transplantation were enrolled.All recipients were given abdominal color ultrasound examinations,and the IAH was measured.The preoperative Child-Pugh score,total operating time,anhepatic phase time,intraoperative blood loss,crystal solution input,colloidal fluid input,red blood cell infusion,plasma infusion,intraoperative total fluid input,intraoperative fluid input per h,and urinary volume per h and their correlation with postoperative IAH were analyzed by the Logistic regression method.The relationship between hemodynamics data and IAH intra-abdominal pressure was analyzed by the correlation analysis of two variables.Result IAH occurred in 18.94％ (18/95) recipients at 72nd h after operation.Fluid input per h (＞2000 ml/h) was risk factor (B=1.62;P＜0.05;OR=5.07,95％ CI:1.41-18.23) of IAH.Urinary volume per h (＜200 ml/h) is risk factor (B=-3.21 ;P＜0.01:OR =0.04,95％ CI:0.01-0.18) of IAH.There was correlation between hepatic artery peak flow velocity (r =0.83,P＜0.01),portal vein peak flow velocity (r =-0.182,P＜0.05),and retrohepatic inferior vena cava peak flow velocity (r=-0.184,P＜0.05) with IAH.Conclusion Fluid input per h should be controlled in a low level and urinary volume per h should be increased in order to prevent IAH.There is correlation between hepatic artery peak flow velocity,portal vein peak flow velocity and retrohepatic inferior vena cava peak flow velocity with IAH.

Comparison of the efficiencies of enteral nutrition with nasogastric tube and endoscopic gastrostomy tube in ICU long-term bedridden patients / 中华临床营养杂志

Objective To compare the efficiencies of enteral nutrition with nasogastric tube with that of enteral nutrition with endoscopic gastrostomy tube in ICU long-term bedridden patients. Methods A total of 6 patients who were admitted in our ICU between January 2008 and September 2009 were enrolled in this study. The expected completion of daily calorie supply, completion of total volume of nutrient fluid feeding, nutrient fluid backstreaming condition, and incidence rate of tube obstruction were compared between those supported with nasogastric tube and endoscopic gastrostomy tube. Results The completion of daily calorie supply and completion of total volume of nutrient fluid feeding were significantly superior in patients who were supported with endoscopic gastrostomy tube than those with nasogastric tube (P = 0. 002 and P = 0. 008, respectively). In addition, nutrient fluid backstreaming condition and incidence rate of tube obstruction were significantly lower than with nasogastric tube (P= 0. 011 and P = 0. 021, respectively). Conclusion Enteral nutrition with endoscopic gastrostomy tube is more efficient in reaching the nutrition support target than with nasogastric tube.

Postoperative two hemodynamics management strategies on the early impact of liver transplantation recipients / 中华器官移植杂志

Objective To investigate early postoperative impact on recipients after liver transplantation with the two hemodynamic management strategies by using the "gold standard" Swan-Ganz catheter and central venous catheter (CVC) to monitor hemodynamics and guide liquid and vasoactive drug therapy.Methods From May 2006 to January 2009,102 from 107 cases of liver transplantations in our hospital were randomly divided into two groups:PAC group (pulmonary artery Swan-Ganz catheter group,n = 52) and CVC group (n = 50 cases).Hemodynamic parameters were monitored.Results There was no significant difference in the general characteristics between two groups In PAC group and CVC group,the mortality during ICU stay was 7.7 % and 4 %; postoperative 28-day mortality was 11.5 % and 8 % ; the median mechanical ventilation time was 26.5 and 24 h; the median ICU stay was 2.5 and 2 days,respectively.There was no significant difference in the aforementioned parameters (P＞0.05).There was no significant difference in renal function and liver function before and 1,5 days after operation,and mean blood lactic acid level 1,2,and 3 days after operation between two groups (P＞0.05).In PAC group and CVC group,transient ventricular arrhythmias occurred in 26 cases and 2 cases Conclusion It is not a good strategy using "gold standard" Swan-ganz catheter to monitor hemynamic parameters and guide therapy after liver transplantation in ICU,and on the contrary,the application of "gold standard" Swan-ganz catheter increases incidence of transient ventricular arrhythmias.