Clinical effect of human serum albumin versus artificial colloidal fluid in patients with cirrhotic ascites undergoing drainage: A Meta-analysis / 临床肝胆病杂志

ObjectiveTo investigate the clinical effect of infusion of albumin versus artificial colloidal fluid after ascites drainage in patients with liver cirrhosis and ascites. MethodsCochrane Library (from 1993 to February 2018) PubMed (from 1966 to February 2018), Embase (from 1990 to February 2018), Chinese Scientific Journal Full-Text Database (from 1994 to February 2018), CBM (from 1978 to February 2018), China Science and Technology Journal Database (from 1989 to February 2018), Chinese Medical Association Digital Periodical Database (from 1997 to February 2018), and related periodicals and conference proceedings were searched for randomized controlled trials (RCTs) on infusion of albumin and artificial colloidal fluid after ascites drainage in patients with liver cirrhosis and ascites. The modified JADAD method and Cochrane systematic review were used for data extraction and literature quality assessment, and a statistical analysis was performed. RevMan 53 was used for the Meta-analysis. ResultsA total of 7 RCTs with 696 patients were included, with 299 patients in the human serum albumin group and 397 in the artificial colloidal fluid group. The human serum albumin group had a significantly lower incidence rate of hyponatremia than the artificial colloidal fluid group (11.04% vs 20.4%, risk ratio ［RR］=0.58, 95% confidence interval ［CI］: 0.40-0.84, P=0.004). There were no significant differences between the two groups in the incidence rates of kidney injury (702% vs 7.81%, RR=0.93, 95%CI: 0.53-1.65, P=0.82), hepatic encephalopathy (6.77% vs 7.45%, RR=0.87, 95%CI: 0.48-1.55, P=0.63), gastrointestinal bleeding (3.91% vs 3.65%, RR=0.97, 95%CI: 0.43-2.22, P=0.95), abdominal infection (522% vs 4.56%, RR=1.07, 95%CI: 052-2.18, P=0.86), and hospital death (12.78% vs 14.59%, RR=0.70, 95%CI: 047-1.02, P=0.06). ConclusionHuman albumin has an advantage over artificial colloidal fluid in reducing hyponatremia after ascites drainage in patients with cirrhotic ascites.

Advances in the application of regional citrate anticoagulation for continuous renal replacement therapy in patients with liver failure / 中华肝脏病杂志

Currently, continuous renal replacement therapy (CRRT) is one of the most important means of organ support methods in critical care medicine. Anticoagulation is an essential part of the treatment process due to its prolonged duration. Patients with liver failure often have coagulation dysfunction and heparin anticoagulant can increase the risk of bleeding, but without heparin anticoagulant, coagulation can easily occur. In addition, an increased volumetric load, hemodynamic instability, nursing workload and other problems are major issues. Therefore, regional citrate anticoagulation (RCA) is the main anticoagulant method for CRRT therapy in patients with liver failure. This article reviews the mechanism, indications, advantages and disadvantages of using RCA to CRRT in hepatic failure.

The mechanism of liver regeneration post-hepatectomy liver failure / 中华肝胆外科杂志

Although the risk of post-hepatectomy liver failure is severe and it affects the prognosis of patients,hepatectomy is the first choice for hepatocellular carcinoma patients.At present,the mechanism of liver regeneration and post-hepatectomy liver failure is unclear.In this paper,we reviewed the liver regeneration for three stages:initiation,proliferation and termination,and also reviewed the mechanism of post-hepatectomy liver failure.