分阶段目标导向液体治疗在肾移植手术麻醉中的应用  

Application of staged goal-directed fluid therapy in anesthesia for renal transplantation

作　　者：郝晓燕[1] 王辉[1] 高守琳 Hao Xiaoyan;Wang Hui;Gao Shoulin(Department of Anesthesiology,Dalian Friendship Hospital,Dalian 116100,China)

机构地区：[1]大连市友谊医院麻醉科,116100

出　　处：《国际麻醉学与复苏杂志》2019年第10期911-914,共4页International Journal of Anesthesiology and Resuscitation

摘　　要：目的探讨分阶段目标导向液体治疗(goal-directed fluid therapy,GDFT)在肾移植手术麻醉中的应用。方法同种异体肾移植手术30例,采用随机数字表法分为A组和B组(每组15例)。A组为分阶段GDFT组[根据手术进程在新肾再灌注前设定每搏量变异度(stroke volume variation,SVV)≤13,再灌注后SVV定于≤10,据此进行液体的管理],B组为常规GDFT组(设定SVV≤13)。分别记录两组患者麻醉后手术前、移植肾再灌注前及再灌注后15 min时的MAP、心率、每搏输出量(stroke volume,SV),术前、术后血乳酸含量,术前及术后1、2、3 d的血Cr含量和尿量。结果两组患者麻醉后手术前的MAP、心率、SV比较,差异无统计学意义(P>0.05),A组患者移植肾再灌注前和再灌注后15 min时MAP和SV明显高于B组(P<0.05);两组患者术后血乳酸含量均较术前增高,差异有统计学意义(P<0.05),而A组患者术后乳酸含量较B组少,差异有统计学意义(P<0.05);两组患者术后1、2、3 d血Cr含量均较术前明显降低,差异有统计学意义(P<0.05),A组患者术后1、2、3 d血Cr含量较B组患者明显降低(P<0.05);两组患者的尿量比较,差异无统计学意义(P>0.05)。结论分阶段GDFT用于肾移植手术麻醉,在保证肾脏充足的灌注下,有利于肾移植术后肾功能的恢复。Objective To observe the application of staged goal-directed fluid therapy(GDFT)in anesthesia for renal transplantation.Methods A total of thirty patients scheduled for allogeneic renal transplantation were randomly divided into two groups,groups A and B(n=15).Group A was given staged goal-directed fluid therapy[stroke volume variation(SVV)≤13 was set in accordance with the surgical progress before refusion in the new kidney and≤10 after refusion,which is the basis of fluid management].Meanwhile,group B was given goal-directed fluid therapy(where SVV≤13 was set).Then,the mean artery pressure(MAP),heart rate and stroke volume(SV)were recorded before the surgery after anesthesia,before refusion in the new kidney and 15 min after refusion.Furthermore,the content of blood lactic acid before and after surgery,the blood creatinine(Cr)content and urine volume before the surgery and 1,2 d and 3 d after surgery were also recorded.Results There was no differences in MAP,heart rate and SV between the two groups before surgery(P>0.05).Group A presented remarkably increases in MAP and SV before refusion and 15 min after refusion,compared with group B(P<0.05).The content of blood lactic acid was marked increased in both groups A and B after surgery(P<0.05),while the increase of lactic acid in group A was significantly lower than that in group B(P<0.05).The Cr content in groups A and B was remarkably decreased 1,2,3 d after surgery,compared with those before surgery(P<0.05),where the Cr content in group A was markedly lower than that in group B 1,2,3 d after surgery(P<0.05).However,no difference was found in urine volume between both groups A and B(P>0.05).Conclusions Application of staged goal-directed fluid therapy in anesthesia for renal transplantation is favorable for recovery of renal functions after renal transplantation,if adequate blood perfusion can be ensured for the kidney.

关 键 词：目标导向液体治疗 每搏量变异度 肾移植 

分 类 号：R61[医药卫生—外科学]