去甲肾上腺素对活体肾移植术中肾灌注及术后肾功能的影响

Effects of norepinephrine on intraoperative graft perfusion and postoperative graft function in living kidney transplantation

中文关键词: 去甲肾上腺素  多巴胺  活体肾移植  阻力指数  移植肾灌注

英文关键词: Norepinephrine  Dopamine  Living kidney transplantation  Resistance index  Renal graft perfusion

中文摘要:

      
目的：比较去甲肾上腺素与多巴胺作为活体肾移植术中血管活性药对术中肾灌注及术后7 d内肾功能的影响。
方法：选择行活体肾移植术的患者94例，男76例，女18例，年龄18～64岁，BMI 18～24 kg/m²，ASA Ⅲ或Ⅳ级。采用随机数法将患者分为两组：去甲肾上腺素组（N组）和多巴胺组（D组），每组47例。麻醉诱导后，N组泵注去甲肾上腺素0.03 mg/kg，D组泵注多巴胺3 mg/kg，维持患者MAP波动幅度小于基础值的10%。于关腹前即刻测量肾动脉阻力指数（RI），记录关腹前即刻和术后24 h的MAP、脉压（PP）、CVP等血流动力学参数和pH、血钾（K⁺）、血乳酸（Lac）等动脉血气指标。记录关腹前即刻心输出量（CO）、每搏变异度（SVV）、血管活性药评分（VIS）。术后24 h复测RI，记录术后1、3、5、7 d内血清肌酐（Scr）、肾小球滤过率（GFR）和术后7 d内移植物功能延迟恢复（DGF）例数。
结果：两组关腹前即刻的MAP、PP、CVP、CO、SVV、VIS，术后24 h MAP、PP、CVP差异均无统计学意义。与关腹前即刻比较，术后24 h 两组K⁺明显降低（P<0.05），两组不同时点Lac差异无统计学意义。N组关腹前即刻和术后24 h RI均不高于D组（95%置信区间下限CL分别为0.087与0.059，均高于非劣效界值Δ=-0.06）。
结论：在活体肾移植术中，使用去甲肾上腺素时的肾灌注不劣效于使用多巴胺，且患者术后7 d内肾功能恢复情况与使用多巴胺效果相同。

英文摘要:

      
Objective: To compare the effect of norepinephrine and dopamine as vasoactive agent in living kidney transplantation on intraoperative graft perfusion and graft function within seven days.
Methods: Ninety-four patients undergoing living-donor kidney transplantation, 76 males and 18 females, aged 18-64 years, BMI 18-24 kg/m², ASA physical status Ⅲ or Ⅳ, were selected and randomly divided into two groups using computer random number method: norepinephrine group (group N) and dopamine group (group D), 47 patients in each group. After anesthesia induction, group N was treated with norepinephrine 0.03 mg/kg, while group D was treated with dopamine 3 mg/kg to keep the patients' MAP fluctuated less than 10% of the baseline. Renal artery resistance index (RI) was measured before closing the abdominal wall and hemodynamic indexes such as MAP, pulse pressure (PP), CVP, and arterial blood gas indexes such as pH, potassium (K⁺) and lactic acid (Lac) were recorded immediately before abdominal closure and 24 hours after operation. Hemodynamic parameters such as cardiac output (CO), stroke variability (SVV), and vasoactive drug score (VIS) were recorded immediately before abdominal closure. RI was re-measured 24 hours after operation, and the serum creatinine (Scr), glomerular filtration rate (GFR), and the incidence of delayed recovery of graft function (DGF) within 1 day, 3, 5, and 7 days after operation were recorded.
Results: There was no significant difference in MAP, PP, CVP, CO, SVV, VIS immediately before abdominal closure, and MAP, PP and CVP 24 hours after operation between the two groups. Compared with immediately before abdominal closure, K⁺ in the two groups decreased significantly 24 hours after operation (P < 0.05), and there was no significant difference in Lac between the two groups at different time points. The RI in group N was not higher than that in group D during operation and 24 hours after operation [the lower limit of 95% confidence interval (CI) of RI was 0.087 during operation and 0.059 after operation, both of which were higher than the non-inferiority threshold Δ = -0.06].
Conclusion: In living kidney transplantation, renal perfusion with norepinephrine is not inferior to that with dopamine, and the recovery of renal function within 7 days after operation is not different from that with dopamine.