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| 目标导向液体治疗对胰-肾联合移植患者预后的影响 |
| Effect of goal-directed fluid therapy on postoperative recovery in patients undergoing simultaneous pancreas-kidney transplantation |
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| DOI：10.12089/jca.2021.08.007 |
| 中文关键词: 目标导向液体治疗 胰-肾联合移植 恢复质量 |
| 英文关键词: Goal-directed fluid therapy Simultaneous pancreas-kidney transplantation Quality of recovery |
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| 中文摘要: |
目的 探讨目标导向液体治疗对胰-肾联合移植患者预后的影响。
方法 选取胰-肾联合移植患者100例，男85例，女15例，年龄18～64岁，ASA Ⅲ或Ⅳ级。根据治疗方法随机分为两组：传统液体治疗组（C组）和目标导向液体治疗组（G组），每组50例。C组术中维持CVP 8～12 mmHg，MAP＞80 mmHg。G组术中根据目标导向液体治疗原则使SVV＜13%，CI＞2.5 L·min-1·m-2，MAP＞80 mmHg。记录术中补液总量、尿量。记录麻醉前（T0）、麻醉后10 min（T1）、肾脏再灌注后10 min（T2）、胰腺再灌注后10 min（T3）、术毕即刻（T4）的MAP。记录术毕的CVP值和血浆脑钠肽（BNP）。监测术前、术后第1、3、5、7天的血淀粉酶、空腹血糖、血肌酐清除率。记录术后外源性胰岛素使用时间、术后首次肛门排气时间和住院期间并发症的发生情况。
结果 与C组比较，G组术中补液总量、尿量明显增多（P＜0.05），T2—T4时MAP明显增高（P＜0.05），术后第1天血淀粉酶和空腹血糖明显降低（P＜0.05），术后第7天血肌酐清除率明显升高（P＜0.05），术后胰岛素使用时间和首次肛门排气时间明显缩短（P＜0.05）。术毕两组CVP、BNP、住院期间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，目标导向液体治疗有利于维持胰-肾联合移植术中循环稳定、改善移植器官灌注、加快移植器官及肠道功能恢复。 |
| 英文摘要: |
Objective To investigate the effect of goal-directed fluid therapy (GDFT) on postoperative recovery in patients undergoing simultaneous pancreas-kidney transplantation.
Methods A total of 100 patients, 85 males and 15 females, aged 18-64 years, ASA physical status Ⅲ or Ⅳ, undergoing simultaneous pancreas-kidney transplantation were included and divided into two groups randomly: conventional fluid therapy group (group C) and GDFT group (group G), 50 patients in each groups. Patients in group C received fluid base on MAP (> 80 mmHg) and CVP (8-12 mmHg). Patients in group G were treated under GDFT strategy with a target of SVV < 13%, CI > 2.5 L·min-1·m-2, MAP > 80 mmHg. MAP was recorded at pre-anesthesia (T0), 10 minutes after anesthesia (T1), 10 minutes after kidney reperfusion (T2), 10 minutes after pancreas reperfusion (T3) and end of surgery (T4). CVP and BNP level were recorded at T4. Creatinine clearance rate, fasting blood-glucose, plasma amylase were detected before surgery and 1, 3, 5, 7 days after surgery. Time of insulin independent and first flatus, major postoperative complications were recorded.
Results Compared with group C, the amount of intraoperative infusion and urinary in group G were significantly higher (P < 0.05), while there was no statistical difference of CVP and BNP between the groups. MAP of group G was much higher than group C at T2-T4 (P < 0.05). Compared with group C, fasting blood-glucose and plasma amylase on 1 day after surgery were decreased significantly, while creatinine clearance rate on 7 days after surgery was increased significantly in group G. Time of insulin independent and first flatus in group G was shorter than that in group C. Major postoperative complications showed no significant difference between the groups.
Conclusion Compared with conventional fluid therapy, GDFT is more beneficial to stabilize circulation, improve graft perfusion and function, accelerate gastrointestinal recovery for simultaneous pancreas-kidney transplantation. |
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