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目的探讨每搏量变异率(stroke volume variation,SVV)目标导向液体治疗在亲属肾移植术患者的优势和可行性。方法 106例择期亲属肾移植手术患者,年龄16~55岁,ASAⅡ~Ⅳ,分为中心静脉压(ceutral venous pressure,CVP)组(n=50)和SVV组(n=56)。常规行有创动脉血压、CVP、心电图、脉搏血氧饱和度(SpO2)监测,SVV组应用FloTrac监测SVV、心排血指数(CI)等参数。患者均全程平衡盐溶液或生理盐水2~5 ml/(kg·h)维持输液;麻醉诱导期输注4%羟乙基淀粉(万汶)5~7 ml/kg;手术开始后输注胶体液约5 ml/(kg·h)。CVP组维持CVP在8~15 cmH2O;SVV组维持SVV≤13%。开放前输注悬浮红细胞400 ml以上维持血红蛋白(Hb)≥80 g/L,开放时维持收缩压140 mmHg以上。记录术中患者血流动力学指标、手术时间、失血量、输液量、血管活性药物使用情况。记录麻醉前,术后1 d、2d、7 d的血清尿素氮(BUN)、肌酐(Cr)及术后相应日期的尿量及转归情况。结果两组患者术后移植肾功能均恢复良好,住院天数差异无统计学意义。胶体液用量SVV组比CVP组明显增多,差异有统计学意义[(1 107.80±311.03)ml vs.(952.00±381.85)ml,P=0.027]。手术后当日尿量SVV组比CVP组明显增多[(1 1407.0±3 227.73)ml vs.(9820.10±4 014.98)ml,P=0.031],术后第5天尿量CVP组比SVV组明显增多[(4 929.80±1 660.75)ml vs.(3 374.80±1 288.33)ml,P=0.000];SVV组患者BUN于术后第1天[(8.12±3.69)mmol/L vs.(9.70±4.48 mmol/L),P=0.056]、第2天[(4.41±3.07)mmol/L vs.(6.60±3.98)mmol/L,P=0.002]比CVP组明显降低;SVV组患者的Cr于术后第2天[(129.55±61.01)μmol/L vs.(178.06±120.72)μmol/L,P=0.012]、第7天[(83.38±29.96)μmol/L vs.(104.79±46.93)μmol/L,P=0.008]比CVP组也明显降低。结论 SVV指导下目标导向液体治疗可安全应用于亲属肾移植手术,可能有助于优化术中的血流动力学参数并改善术后肾功能。
Objective To investigate the advantages and feasibility of stroke volume variation (SVV) target-directed fluid therapy in relative renal transplantation. Methods One hundred and sixty patients undergoing elective kidney transplant were aged 16 to 55 years old and ASA Ⅱ to Ⅳ. Patients were divided into two groups: n = 50 for CVV (n = 50) and SVV (n = 56). Conventional arterial blood pressure, CVP, electrocardiogram, pulse oximetry (SpO2) monitoring, SVV group using FloTrac monitoring SVV, cardiac output index (CI) and other parameters. Patients were balanced saline solution or normal saline 2 ~ 5 ml / (kg · h) infusion; anesthesia induced infusion of 4% hydroxyethyl starch (Van Wensheng) 5 ~ 7 ml / kg; Body fluid about 5 ml / (kg · h). CVP group maintained CVP at 8 ~ 15 cmH2O; SVV group maintained SVV≤13%. Open before transfusion of suspended erythrocytes 400 ml or more to maintain hemoglobin (Hb) ≥ 80 g / L, open to maintain systolic blood pressure 140 mmHg above. The intraoperative hemodynamic parameters, operation time, blood loss, infusion volume and vasoactive drug use were recorded. The levels of serum urea nitrogen (BUN), creatinine (Cr) and the corresponding postoperative day 1 d, 2 d and 7 d after anesthesia were recorded. Results The postoperative renal allograft function of both groups recovered well and there was no significant difference in days of hospitalization. The amount of colloidal fluid in SVV group was significantly higher than CVP group, the difference was statistically significant [(1 107.80 ± 311.03) ml vs. (952.00 ± 381.85) ml, P = 0.027]. The volume of urine volume in the SVV group was significantly higher than that in the CVP group on the day after surgery [(11407.0 ± 3 227.73) ml vs. (9820.10 ± 4 014.98) ml, P = 0.031] [(4 929.80 ± 1 660.75) ml vs. (374.80 ± 1 288.33) ml, P = 0.000]. The level of BUN in SVV group was significantly higher on the first postoperative day (8.12 ± 3.69 mmol / L vs. 9.70 ± 4.48 (4.41 ± 3.07) mmol / L vs. (6.60 ± 3.98) mmol / L, P = 0.002] in the second day compared with the CVP group Day after [(129.55 ± 61.01) μmol / L vs. (178.06 ± 120.72) μmol / L, P = 0.012] and on day 7 [(83.38 ± 29.96) μmol / L vs. (104.79 ± 46.93) μmol / L, P = 0.008] was also significantly lower than the CVP group. Conclusion SVV-directed liquid therapy can be safely applied to renal transplantation in relatives. It may be helpful to optimize intraoperative hemodynamic parameters and improve postoperative renal function.