Background:Hepatic chemosaturation for inoperable liver tumors is a palliative treatment option with a beneficial effect on survival. However, the procedure regularly leads to circulatory failure during the filtration phase, and hemodynamic management is challenging. Our study aimed to compare two different strategies for hemodynamic management during chemosaturation to develop hypotheses for improving patient care and reducing peri-interventional morbidity.Methods:We conducted a single-center retrospective cohort study including 66 procedures of chemosaturation between May 2016 and March 2024. Procedures were divided into two groups: group 1 was managed with norepinephrine as the only vasopressor and liberal use of hydroxyethyl starch (HES). Group 2 was managed with norepinephrine and vasopressin and the preferred use of balanced crystalloids. We compared these two groups with respect to hemodynamic parameters, laboratory values, and post-interventional complications.Results:The heart rate was highest and the mean arterial pressure (MAP) was lowest during the filtration phase in both groups (p= 0.868,p= 0.270). The vasoactive inotropic score (VIS) was significantly higher in group 2 during the filtration phase (31.5 vs. 89,p< 0.001). Group 1 received significantly more HES overall (1000 mL vs. 0 mL,p< 0.001). Lactate levels at admission to the ICU were higher in group 1 (22.9 vs. 14.45 mg/dL,p= 0.041). Platelet counts were lower in group 2 from directly after chemosaturation through day 2 (p= 0.022,p= 0.001,p= 0.032). The INR differed significantly directly after chemosaturation (1.13 vs. 1.26,p= 0.015). Overall, group 1 received significantly more blood products peri-interventionally. There were two bleedings and one ischemic stroke in the overall cohort. There was no peri-interventional mortality.Conclusions:Advanced hemodynamic management ensures low peri-interventional mortality and morbidity. High-dose vasopressors, including vasopressin and the preferred use of balanced crystalloids, are sufficient to stabilize circulatory function during chemosaturation.
背景：对于无法手术的肝脏肿瘤，肝脏化学饱和疗法是一种姑息性治疗选择，对患者生存有益。然而，该操作在过滤阶段常导致循环衰竭，血流动力学管理具有挑战性。本研究旨在比较化学饱和疗法期间两种不同的血流动力学管理策略，以提出改善患者护理和降低围手术期发病率的假设。 方法：我们进行了一项单中心回顾性队列研究，纳入了2016年5月至2024年3月期间的66例化学饱和疗法操作。操作分为两组：第1组仅使用去甲肾上腺素作为血管加压药，并自由使用羟乙基淀粉进行管理；第2组使用去甲肾上腺素和血管加压素，并优先使用平衡晶体液进行管理。我们比较了两组在血流动力学参数、实验室数值以及术后并发症方面的差异。 结果：两组患者在过滤阶段的心率均最高，平均动脉压均最低（p=0.868，p=0.270）。在过滤阶段，第2组的血管活性正性肌力药物评分显著高于第1组（31.5 vs. 89，p<0.001）。第1组总体上接受的羟乙基淀粉量显著更多（1000 mL vs. 0 mL，p<0.001）。入住ICU时，第1组的乳酸水平更高（22.9 vs. 14.45 mg/dL，p=0.041）。从化学饱和疗法结束后至术后第2天，第2组的血小板计数较低（p=0.022，p=0.001，p=0.032）。化学饱和疗法结束后，两组的国际标准化比值存在显著差异（1.13 vs. 1.26，p=0.015）。总体而言，第1组在围手术期接受的血液制品显著更多。整个队列中发生了两例出血事件和一例缺血性卒中。围手术期无死亡病例。 结论：先进的血流动力学管理确保了较低的围手术期死亡率和发病率。包括血管加压素在内的大剂量血管加压药以及优先使用平衡晶体液，足以在化学饱和疗法期间稳定循环功能。
肿瘤(癌症)患者之家