血流动力学监测指导下肾移植术中去甲肾上腺素的应用

张凯璐; 李兵; 张宇; 祝丽芬

血流动力学监测指导下肾移植术中去甲肾上腺素的应用

昆明医科大学附属甘美医院麻醉科

基金项目:

基金：昆明市科技计划基金资助项目 (2015-2-S-01999);

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出版历程
- 收稿日期: 2018-03-14

An Application of Norepinephrine in Renal Transplantation Guided by Hemodynamic Monitoring

Funds:

基金：昆明市科技计划基金资助项目 (2015-2-S-01999);

摘要

摘要: 目的探讨肾移植术中不同监测手段下指导去甲肾上腺素的使用及其对预后的临床意义.方法同种异体肾移植术患者40例, 随机分为经外周血流动力学监测组 (E组) 和常规监测组 (N组) , 每组20例, 分别记录2组患者麻醉诱导后 (T1) 、手术开始前 (T2) 、髂外静脉阻断后 (T3) 、髂外静脉开放后 (T4) 、手术结束 (T5) 时间点的MAP (平均动脉压) 、CVP (中心静脉压) 、HR (心率) 的值, 术中各时间段去甲肾上腺素的用量, 术中出入量以及术后3 d肾功能指标、住院天数等进行对比研究.结果术中E组去甲肾上腺素的用量明显低于N组 (P<0.05) ;术中E组尿量明显高于N组 (P<0.05) ;术中输液量、出血量以及术后3 d肾功能指标2组间差异无统计学意义 (P>0.05) .结论经外周心排量监测血流动力学明显减少了肾移植术中去甲肾上腺素的用量, 减少了造成肾损伤的风险, 增加术中尿量, 对于术中血管活性药物的管理更为精准化、个体化.
- 去甲肾上腺素 /
- 肾移植 /
- 外周血管阻力 /
- 每搏变异度
Abstract: Objective To investigate the use of noradrenaline under different monitoring methods in renal transplantation and its clinical significance in prognosis. Methods 40 patients under the surgery of renal allograft were randomly divided into two groups (20 patients each) : Flotrac-vigileo group (E) and the standard monitoring group (N) , then we recorded MAP (mean arterial pressure) , CVP (central venous pressure) and HR (heart rate) value divided by 5 periods: after induction of general anesthesia (T1) , before operation (T2) , external iliac vein occlusion (T3) , external iliac vein opening (T4) and the end of operation (T5) .Meanwhile, intraoperative norepinephrine dosage, intake and output volumnand renal function indicators during postoperative and after three days were also studies. Length of hospital stay were also compared in this essay.Results The amount of norepinephrine in group E during operation was significantly lower than that in group N (P<0.05) . The urine volume in group E during operation was significantly higher than that in group N (P<0.05) . There was no significant difference between the two groups in the amount of transfusion, blood loss and the indexes of kidney function. Conclusions Hemodynamics monitored by peripheral cardiac output significantly reduced the amount of norepinephrine used in renal transplantation, also in the risk of renal damage. Yet it increased the amount of intraoperative urine output, which provided more accurate and personalized management of intraoperative vasoactive drugs.
- Norepinephrine /
- Kidney transplantation /
- Peripheral vascular resistance /
- Stroke variation

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