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| 目标导向液体治疗对肾移植术后早期功能恢复及并发症的影响 |
| Impact of goal-directed fluid therapy on early graft function and postoperative complications of kidney transplantation |
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| DOI：10.12089/jca.2020.10.010 |
| 中文关键词: 目标导向液体治疗 肾移植 并发症 预后 |
| 英文关键词: Goal-directed fluid therapy Kidney transplantation Complications Prognosis |
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| 中文摘要: |
目的 探讨目标导向液体治疗对肾移植术后早期功能恢复及并发症的影响。
方法 选取肾移植患者100例，男67例，女33例，年龄18～65岁，ASA Ⅲ或Ⅳ级，将患者随机分为两组：目标导向液体治疗组（G组）和传统液体治疗组（C组），每组50例。G组根据目标导向液体治疗原则调整补液速度使每搏变异度（SVV）＜13%，心脏指数（CI）＞2.5 L·min-1·m-2，MAP＞80 mmHg。C组术中调整补液速度以维持CVP 8～12 mmHg，MAP＞80 mmHg。记录术中补液量、尿量及术后第1天、第2天尿量。于麻醉后10 min（T0）、移植肾动脉开放后10 min（T1）、术毕即刻（T2）抽取动脉血，测定氧合指数、乳酸和血钾浓度。计算术前、术后1、2、3、4、5、6、7、14 d和术后1、3、6个月的肌酐清除率。记录术后心脑血管并发症、肺部并发症、早期急性排斥反应、移植肾功能恢复延迟等并发症的发生情况。
结果 G组术中补液量、尿量、术后第1天尿量明显多于C组（P＜0.05）。T2时G组血钾浓度明显低于C组（P＜0.05）。两组不同时点氧合指数和乳酸浓度差异无统计学意义。术后30、90 d G组肌酐清除率明显高于C组（P＜0.05），其余时点两组肌酐清除率差异无统计学意义。两组术后并发症发生率差异无统计学意义。
结论 与传统液体治疗比较，目标导向液体治疗能改善移植肾早期灌注，加快肾功能恢复。 |
| 英文摘要: |
Ojective To investigate the impact of goal-directed fluid therapy (GDFT)on early graft function and postoperative complications of kidney transplantation.
Methods A total of 100 recipients undergoing kidney transplantation, 67 males and 33 females, aged 18-65 years, falling into ASA physical status Ⅲ or Ⅳ, were included and divided into two groups randomly (n = 50): GDFT group (group G) and conventional fluid therapy group (group C). Group G was performed targeting SVV ＜ 13%, CI ＞ 2.5 L·min-1·m-2, MAP ＞ 80 mmHg. Conventional fluid therapy with fluid titration at a CVP of 8-12 mmHg and MAP > 80 mmHg was applied to group C. The volume of fluid and urine volume during the operation and the urine volume on the first and second days after surgery were recorded. Oxygenation index, lactic acid and potassium of artery blood samples were recorded 10 min after anesthesia (T0), 10 min after kidney artery unclamped (T1) and at the end of surgery (T2). Urine volume on day 1 and day 2 after surgery were recorded. Creatinine clearance rates were recorded before surgery and on day 1-7, 14, 30, 90, 180 after surgery. Major postoperative complications included cardiovascular complications, pulmonary complications, early acute rejection, and delayed graft failure were recorded.
Results Compared with group C, intraoperative infusion and urine volume, urine volume on day 1 after surgery were significantly higher in group G (P < 0.05). The potassium in group G was much lower than that in group C at T2(P < 0.05). There was no significant difference in oxygenation index and lactic acid concentration between the two groups at different time points. Creatinine clearance rates were much higher in group G than in group C on day 30 and 90 after surgery (P < 0.05). Major postoperative complications showed no significant difference between the two groups.
Conclusion Compared to conventional fluid therapy, GDFT has more benefits to improve early graft function. |
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