经食道超声多普勒指导的目标导向液体治疗在活体肾移植术中的应用

目的 观察经食道超声多普勒(TED)指导的目标导向液体治疗策略在活体肾移植术中的应用效果.方法 100例择期行活体肾移植手术患者,ASAⅢ~Ⅳ级,随机分为以TED为导向的TED组和以中心静脉压(CVP)为导向的CVP组.记录患者麻醉前(T0)、麻醉诱导后10 min(T1)、肾动脉血流开放前(T2)、肾动脉血流开放后15 min(T3)、手术结束时(T4)的血流动力学指标及术中出血量、输液量、手术时间.记录麻醉前和术后1、2、4、10 d及1、3个月的尿素氮、肌酐及术后相应日期的尿量及转归情况.结果 T3时两组平均动脉压(MAP)均降低(P<0.01),两组患者术中不同观察时间点MAP差异无统计学意义;CVP组CVP在T2、T3、T4时都高于TED组(P<0.05).TED组患者术中输液量少于CVP组(P<0.01),血管活性药物使用率无明显差异,TED组术后组织水肿、拔管后需面罩吸氧发生率低于CVP组.两组患者术后肾功能指标无差异.结论 TED指导的目标导向液体治疗策略可安全应用于活体肾移植手术,与传统的以CVP为导向的液体管理方案相比,术后肾功能的恢复无差异,但术中输液量更少,液体超负荷相关的并发症发生率更低,有助于改善肾移植患者术后转归.

Application of goal-directed fluid therapy directed by transesophageal Doppler in patients undergoing living donor renal transplant surgery

Objective To observe the application of goal-directed fluid therapy directed by transesophageal Doppler ( TED) in patients undergoing living donor renal transplant surgery. Methods 100 patients undergoing living donor renal transplant surgery, ASA Ⅲ~Ⅳ,were randomly divided into routine fluid therapy group(group CVP) and goal-directed fluid therapy group monitered with TED( group TED) using random digits table. Hemodynamic param-eters of two groups were recorded before anesthesia(T0),10 minutes after induction of anesthesia(T1), before o-pening of renal artery( T2 ) ,15 minutes after opening renal artery( T3 ) and the end of surgery( T4 ) . The amount of bleeding, infusion fluid and operative time were recorded. Urea nitrogen, creatinine, urine outputs were recorded before surgery and on days 1, 2, 4, 10 and at 1 and 3 months after surgery. Results The MAP of both groups at T3 were lower than before anesthesia(P<0. 01),the CVP of group TED was higher than group CVP at the point of T2,T3 and T4(P<0. 05). The amount of intraoperative fluid given in group TED was lower than in group CVP(P<0. 01 ) . Side-effects like postoperative dyspnoea and tissue edema were higher in group CVP. The postoperative graft function was comparable. Conclusion TED-guided intraoperative fluid therapy achieve the same rate of immediate graft function as CVP-guided fluid therapy but use a significantly less amount of fluid. The incidence of postopera-tive complications related to fluid overload is also reduced.