دانلود رایگان مقاله انگلیسی تحلیل امپدانس بیوالکتریک؛ ارزیابی لنفادم، وضعیت مایع و آسیب بافت پس از عمل جراحی زنان - الزویر 2018

ABSTRACT

The aim of this descriptive review is to summarise the current knowledge of non-invasive bioelectrical impedance analysis (BIA) used with gynaecological surgical patients in regard to postoperative development of lymphoedema and determination of perioperative fluid balance, and as a prognostic factor in cancer mortality and a predictor of postoperative complications. The databases PubMed, MEDLINE, Scopus Web of Science, the Cochrane Library, and reference lists of selected articles were searched for relevant articles published during the period January 2008–April 2018. Only papers published in English were retrieved. Thirty-seven articles were evaluated. Where gynaecological studies were lacking, studies with a study population from neighbouring clinical fields were used instead. Studies on the clinical use of BIA with gynaecological surgical patients were divided into three categories: the postoperative development of lower limb lymphoedema (n = 7), perioperative hydration measuring (n = 3), and the BIA parameter phase angle as a prognostic factor in cancer survival and as predictive for postoperative complications (n = 6). Of these 16 studies only three used a pure gynaecological study population. Three different methods of BIA were used in these articles: single frequency-BIA, multifrequency-BIA and bioimpedance spectroscopy. BIA was found to detect lymphoedema with a sensitivity of 73% and a specificity of 84%. Studies indicated that BIA was able to detect lower limb lymphoedema at an early stage even before it became clinically detectable. During postoperative hydration measurements, an increase in extracellular fluid volume and extracellular fluid volume in relation to total body fluid volume, as well as a decrease in phase angle, were associated with higher frequencies of postoperative complications. Moreover, low values for the phase angle have been associated with increased mortality in cancer patients. However, the number of studies in this field was limited. From our review, BIA seems to be a useful tool for use in the clinical setting of the gynaecological surgical patient. The theoretical approach of using bioelectrical impedance values to measure the fluid distribution in the body compartments offers wide opportunities in the clinical setting. However, so far, all studies have set up cut-off limits within the study population, and reference values for a general population need to be defined. There are also rather few studies on a gynaecological study population. Hence, there is a need for further studies within gynaecological surgery focusing on early detection of lower limb lymphoedema, perioperative fluid balance, and postoperative complications in order to establish the value of BIA in clinical praxis.

Results

The selection of articles is summarised in the flow chart (Fig. 3). Thirty-seven articles were evaluated. Studies on BIA within gynaecological surgical patients (n = 16) were divided into three categories: BIA and lower limb lymphoedema (n = 7), BIA and perioperative hydration measuring (n = 3), and PhA as a prognostic factor in cancer survival and as predictive for postoperative complications (n = 6).

The bioimpedance method and development of lymphoedema

Rather few studies have been published concerning BIA and LLL following gynaecological surgery. Table 2 summarises the studies, whichusedBIA to detectLLL,published between2008 and 2018. Ofthe seven reviewed articles, four were from the same research group [10– 12,14], and only two concerned women after gynaecological surgery [7,13]. BIS was the most commonly used BIA method; only one study used MF-BIA [7]. Previous studies performed on upper limb LO after breast cancer surgery and axillary node dissection have proposed BIS to be the preferred BIA method to detect LO [30] with a sensitivity of 73% and a specificity of 84% [31]. Hayes et al. suggested that BIS was less capable of detecting LO in the genital area following vulvar/vaginal surgery [13]. However, the equipment used in their study was not able to assess body fluids in the central compartment of the body [13], thus was not able to detect LO that develops in the pelvic area. In contrast, the MF-BIA has been suggested to detect LLL even before subjective symptoms appear [7]. There are several ways to interpret and estimate LLL by using the BIA parameters. The ECV/ICV ratio [11,15] and ECV/TBV [7] ratio have been used to detect LLL. Another method has been to compare the ratio of the ECV in the respective lower extremities, ECV1/ECV2 [10]. The ECV of the upper extremity can also serve as a reference value when investigating the lower limbs [12]. An impedance ratio of ECV/ICV exceeding 1.136 has been suggested as reference value for the presence of LLLA [15].