不同导向的补液方式对同种异体肾移植手术患者肾血流灌注、肾功能恢复及液体平衡的影响  

The effects of different oriented fluid supplement methods on renal blood perfusion,renal function recovery and fluid balance in patients undergoing allogeneic kidney transplantation

作　　者：李利忍 王文静[1] 刘永波[1] Li Liren;Wang Wenjing;Liu Yongbo(Central Surgery Department,Zhengzhou People’s Hospital,Zhengzhou 450000,China)

机构地区：[1]郑州人民医院中心手术部,450000

出　　处：《国际移植与血液净化杂志》2022年第3期25-28,共4页International Journal of Transplantation and Hemopurification

摘　　要：目的:对比不同导向的补液方式对同种异体肾移植手术患者肾血流灌注、肾功能恢复及液体平衡的影响。方法:选取我科2018年8月至2021年2月期间收治的81例同种异体肾移植手术患者作为研究对象,按照干预方式不同分成两组,对照组40例给予以中心静脉压(central venous pressure,CVP)、尿量为导向的传统补液,观察组41例给予经食管多普勒超声(transesophageal Doppler ultrasound,TED)指导的目标导向液体干预。对比两组患者肾血流灌注、肾功能及液体平衡。结果:两组患者手术结束时平均动脉压(mean arterial pressure,MAP)、CVP值均下降,但观察组下降幅度低于对照组(P<0.05)。两组患者术后3 d血清中肌酐(creatinine,Cr)、尿素氮(urea nitrogen,BUN)水平均降低,但观察组降低幅度高于对照组(P<0.05)。观察组术后1 d及术后3 d的输液量均低于对照组,尿量均高于对照组(P<0.05)。结论:TED指导的目标导向液体干预较以CVP和尿量为导向的传统补液干预应用效果更好,能有效改善同种异体肾移植手术患者肾血液灌注,促进肾功能恢复,维持液体平衡。Objective To compare the effects of different oriented fluid supplement methods on renal blood perfusion,renal function recovery and fluid balance in patients undergoing allogeneic kidney transplantation.Methods From August 2018 to February 2021,81 patients undergoing allogeneic kidney transplantation in our department were selected as the research objects.The patients were divided into two groups according to different intervention methods.Forty patients in the control group were given with central venous pressure(CVP)and urine volume-oriented traditional fluid rehydration,41 patients in the observation group were given with goal-oriented fluid intervention guided by transesophageal Doppler ultrasound(TED).Renal blood perfusion,renal function,and fluid balance were compared between the two groups.Results The mean arterial pressure(MAP)and CVP values of the two groups wene decreased at the end of the operation,but the decrease in the observation group was lower than that in the control group(P<0.05).The levels of creatinine(Cr)and urea nitrogen(BUN)in the serum of the two groups were decreased at 3 days postoperatively,but the decrease in the observation group was higher than that in the observation group(P<0.05).The infusion volume of the observation group was lower than that in the control group at 1 and 3 days after the operation,and the urine volume was higher than in the control group(P<0.05).Conclusion TED-guided goal-oriented fluid intervention was more effective than traditional fluid supplement intervention based on CVP and urine output.It could effectively improve renal blood perfusion in patients with allogeneic kidney transplantation,promote renal function recovery,and maintain fluid balance.

关 键 词：目标导向液体 同种异体肾移植 血流灌注 肾功能 液体平衡 

分 类 号：R699.2[医药卫生—泌尿科学]