心排血量导向性循环管理对儿童活体肝移植受者肾脏的保护作用  

Effect of cardiac output-guided hemodynamic management on acute kidney injury during pediatric liver transplantation

作　　者：窦晓婧[1] 王清平[1] 翁亦齐[1] 刘伟华[1] 喻文立[1] Dou Xiaojing;Wang Qingping;Weng Yiqi;Liu Weihua;Yu Wenli(Department of Anesthesiology,Tianjin First Central Hospital,Tianjin 300192,China)

机构地区：[1]天津市第一中心医院麻醉科,300192

出　　处：《中华器官移植杂志》2021年第12期728-732,共5页Chinese Journal of Organ Transplantation

基　　金：天津市自然科学基金面上项目(18JCYBJC27500);国家自然科学基金面上项目(82072219)。

摘　　要：目的探讨心排血量导向性循环管理对儿童活体肝移植术中肾脏的保护作用。方法选取2019年6月至2019年12月天津市第一中心医院接受活体肝移植术的120例儿童受者(均诊断为先天性胆道闭锁),随机数字法分成常规组(60例)和实验组(心排血量导向性循环管理实验组,60例)。常规组根据中心静脉压(CVP)、连续有创动脉压、血气分析等监测指导术中循环管理,实验组根据心指数、每搏指数、每搏变异度(SVV)、左心室收缩力指数(DP/DTmax)等指标进行心排血量为目标导向的循环管理。比较两组儿童受者术中血流动力学情况,术后急性肾损伤(AKI)的发生率以及肾损伤指标血清中性粒细胞明胶酶相关脂钙蛋白(NGAL)、胱抑素C及炎症因子的变化。结果实验组术后AKI发生率低于常规组(26.7%比45%,P<0.05)。实验组儿童受者术中再灌注后综合征(PRS)发生率,术中补液量、最高中心静脉压(CVP)低于常规组,最低平均动脉压(MAP)高于常规组(P<0.05)。实验组血清NGAL、胱抑素C以及白细胞介素(IL)-6、IL-18和肿瘤坏死因子α(TNF-α)浓度从术中新肝期3 h至术后48 h内的各时间点均低于常规组,差异有统计学意义(P<0.05)。结论儿童活体肝移植术中心排血量目标导向性循环管理可以稳定受者循环,减少再灌注后综合征(PRS),精准液体入量,减少术后AKI的发生率。Objective To explore the effect of cardiac output-guided hemodynamic management on acute kidney injury(AKI)during pediatric liver transplantation.Methods A total of 120 pediatric living-donor liver transplantation recipients were randomly divided into two groups of control and experiment(60 cases each group).Control group received routine hemodynamic management of central venous pressure(CVP),continuous invasive arterial pressure and blood gas analysis.Experiment group was subjected to cardiac output-guided hemodynamic management guided by cardiac index,stroke volume index,stroke volume variation and left ventricular contractility index(DP/DTmax).Intraoperative hemodynamics and incidence of AKI were recorded.And the serum changes of neutrophil gelatinase-associated lipocalin(NGAL),cystatin C(CysC)and inflammatory factors were analyzed.Results The incidence of AKI was lower in experiment group than that in control group(26.7%vs 45%).The incidence of postreperfusion syndrome(PRS),intraoperative fluid infusion and maximal value of CVP were lower while minimal value of mean arterial pressure(MAP)higher in experiment group than those in control group(P<0.05).The serum levels of NGAL,CysC,interleukin-6(IL-6),interleukin-18(IL-18)and tumor necrosis level-alpha(TNF-α)were lower in experiment group than those in control group at each timepoint from 3 h post-reperfusion to 48 h post-operation(P<0.05).Conclusions During pediatric living-donor liver transplantation,cardiac output-guided hemodynamic management is conducive to more accurate fluid management.It can stabilize circulation,minimize PRS and reduce the occurrence of AKI during perioperative period.

关 键 词：肝移植 心排血量 急性肾损伤 

分 类 号：R726.5[医药卫生—儿科]