scholarly journals Influencing factors of serum lactate in patients undergoing partial hepatectomy with fluid restriction: a prospective cohort study

2019 ◽  
Author(s):  
Ling Yu ◽  
Hongwei Sun ◽  
Huangmo Jin ◽  
Hongyu Tan
Keyword(s):  
Blood Pressure ◽  
Cohort Study ◽  
Liver Lesion ◽  
Lactate Clearance ◽  
Serum Lactate ◽  
Fluid Restriction ◽  
Liver Lesions ◽  
Portal Triad ◽  
Fluid Infusion ◽  
Portal Triad Clamping

Abstract Background: This prospective cohort study was designed to investigate the factors related to serum lactate in hepatectomy patients with fluid restriction before resection of liver lesions. Methods: Patients for an open procedure for elective partial hepatectomy were chosen for this study. Limited fluid was infused at a rate of 6 ml·kg -1 ·h -1 before liver resection. The infusion speed was increased after resection of liver lesion. Stable hemodynamics was maintained by additional fluid infusion or vasoconstrictor drug. An additional infusion of 200 ml crystalloid liquid over ten min was given when urine output was less than 20ml/h, and/or when systolic blood pressure was less than 90mmHg for 1 minute and for more than 3 times. An injection of 6mg Ephedrine was given when the systolic blood pressure was less than 90 mm Hg for 1 minute. The duration of portal triad clamping, the central venous pressure (CVP), the frequency of additional fluid infusion , the frequency of ephedrine , and the intraoperative blood loss were recorded. The serum lactate was measured from arterial blood-gas analysis at 4 time points: T1: before anesthesia; T2: after liver dissection, and immediately before liver resection; T3: 10 min after the liver lesion was removed; and T4: before the patient was discharged from the post-anesthesia care unit . The lactate clearance rate was calculated and linear regression analysis was employed to identify the relationship between serum lactate level and the influence factors. Results: The highest serum lactate was observed at T3 in all 110 patients. Lactate clearance rate averaged 14.4±17.2% in all patients. The i nfluence factors contributed to the highest serum lactate listed by level of importance: duration of portal triad clamping, frequency of ephedrine, operation time. Conclusions: Hepatic portal clamping can result in the increase of serum lactate. The inadequate perfusion of organ during the fluid restriction may be due to increased serum lactate. Accelerated fluid infusion after resection of liver lesions can improve the tissue perfusion. Trial registration: The registration number is ChiCTR1900023167. Retrospectively registered on 14th, May, 2019

scholarly journals Association between polymorphism at IGF-1 rs35767 gene locus and long-term decline in renal function: a Japanese retrospective longitudinal cohort study

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Kosuke Honda ◽  
Satoru Kuriyama ◽  
Kimiyoshi Ichida ◽  
Tomoko Nakano ◽  
Naoki Sugano ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Metabolic Syndrome ◽  
Renal Function ◽  
Uric Acid ◽  
Cohort Study ◽  
Serum Uric Acid Level ◽  
Human Growth ◽  
Longitudinal Cohort Study ◽  
Longitudinal Cohort

Abstract Background Insulin-like growth factor-1 (IGF-1) acts on glucose and protein metabolism and human growth and also influences blood pressure and renal function. This study investigated whether the single-nucleotide polymorphism of IGF-1, rs35767, plays a role in metabolic syndrome indicators, including blood pressure, glucose metabolism, uric acid levels, and renal function. Methods In this retrospective longitudinal cohort study, blood samples from 1506 Japanese individuals were collected and used for genotyping for variant rs35767: T > C in the IGF-1 upstream promoter. Data were analyzed to identify associations between IGF-1 genotypes and patient biochemical parameters, including the components of metabolic syndrome and the long-term change in renal function. Results The cohort rs35767 genotypes included 650 CC carriers (43.2%), 687 TC carriers (45.6%), and 169 TT carriers (11.2%). Multiple regression analysis revealed no association between IGF-1 genotype and blood pressure, glycated hemoglobin level, and serum uric acid level. However, in females, blood pressure was negatively correlated with the TT genotype. Longitudinal observation revealed that the decline in eGFR over 10 years was greater in TT (− 18.51 ± 1.04 mL/min/1.73m2) than in CC carriers (− 16.38 ± 0.52 mL/min/1.73m2; P < 0.05). Conclusion The present study suggests that renal function declines faster in individuals with the TT genotype at the IGF-1 rs35767 locus than in those with the CC genotype, suggesting that the TT genotype is associated with the long-term chronological decline in renal function.

scholarly journals Is therapeutic inertia present in hyperglycaemia, hypertension and hypercholesterolaemia management among adults with type 2 diabetes in three health clinics in Malaysia? a retrospective cohort study

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Boon-How Chew ◽  
Husni Hussain ◽  
Ziti Akthar Supian
Keyword(s):  
Blood Pressure ◽  
Type 2 Diabetes ◽  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Ldl Cholesterol ◽  
Therapeutic Inertia ◽  
Treatment Targets ◽  
Health Clinics

Abstract Background Good-quality evidence has shown that early glycaemic, blood pressure and LDL-cholesterol control in people with type 2 diabetes (T2D) leads to better outcomes. In spite of that, diseases control have been inadequate globally, and therapeutic inertia could be one of the main cause. Evidence on therapeutic inertia has been lacking at primary care setting. This retrospective cohort study aimed to determine the proportions of therapeutic inertia when treatment targets of HbA1c, blood pressure and LDL-cholesterol were not achieved in adults with T2D at three public health clinics in Malaysia. Methods The index prescriptions were those that when the annual blood tests were reviewed. Prescriptions of medication were verified, compared to the preceding prescriptions and classified as 1) no change, 2) stepping up and 3) stepping down. The treatment targets were HbA1c < 7.0% (53 mmol/mol), blood pressure (BP) < 140/90 mmHg and LDL-cholesterol < 2.6 mmol/L. Therapeutic inertia was defined as no change in the medication use in the present of not reaching the treatment targets. Descriptive, univariable, multivariable logistic regression and sensitive analyses were conducted. Results A total of 552 cohorts were available for the assessment of therapeutic inertia (78.9% completion rate). The mean (SD) age and diabetes duration were 60.0 (9.9) years and 5.0 (6.0) years, respectively. High therapeutic inertia were observed in oral anti-diabetic (61–72%), anti-hypertensive (34–65%) and lipid-lowering therapies (56–77%), and lesser in insulin (34–52%). Insulin therapeutic inertia was more likely among those with shorter diabetes duration (adjusted OR 0.9, 95% CI 0.87, 0.98). Those who did not achieve treatment targets were less likely to experience therapeutic inertia: HbA1c ≥ 7.0%: adjusted OR 0.10 (0.04, 0.24); BP ≥ 140/90 mmHg: 0.28 (0.16, 0.50); LDL-cholesterol ≥ 2.6 mmol/L: 0.37 (0.22, 0.64). Conclusions Although therapeutic intensifications were more likely in the presence of non-achieved treatment targets but the proportions of therapeutic inertia were high. Possible causes of therapeutic inertia were less of the physician behaviours but might be more of patient-related non-adherence or non-availability of the oral medications. These observations require urgent identification and rectification to improve disease control, avoiding detrimental health implications and costly consequences. Trial registration Number NCT02730754, April 6, 2016.

scholarly journals Evaluation of Stroke Volume Variation Obtained by the FloTrac™/Vigileo™ System to Guide Preoperative Fluid Therapy in Patients Undergoing Brain Surgery

2012 ◽  
Vol 40 (3) ◽  
pp. 1175-1181 ◽  
Author(s):  
J Li ◽  
Fh Ji ◽  
Jp Yang
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Stroke Volume ◽  
Stroke Volume Variation ◽  
Brain Surgery ◽  
Fluid Loading ◽  
Volume Loading ◽  
Fluid Infusion ◽  
Volume Variation ◽  
Ringer’S Lactate

OBJECTIVE: The accuracy of stroke volume variation (SVV) obtained by the FloTrac™/Vigileo™ system in otherwise healthy patients undergoing brain surgery was assessed. METHODS: Anaesthesia was induced in 48 patients with minimal fluid infusion. Before surgery, fluid volume loading was performed by infusion with Ringer's lactate solution in 200 ml steps over 3 min, repeated successively if the patient responded with an increase in stroke volume of ≥ 10%, until the increase was < 10% (nonresponsive). RESULTS: A total of 157 volume loading steps were performed in the 48 patients. Responsive and nonresponsive steps differed significantly in baseline values of blood pressure, heart rate and SVV. Significant correlations were found between the change in stroke volume after fluid loading and values of blood pressure, heart rate and SVV before fluid loading, with SVV the most sensitive variable. CONCLUSION: Stroke volume variation obtained using the FloTrac™/Vigileo™ system is a sensitive predictor of fluid responsiveness in healthy patients before brain surgery.

Sign in / Sign up

Export Citation Format

Share Document