容量调控对腹腔镜活体肾移植术供肾者机体氧代谢的影响

Effects of capacity control on oxygen metabolism of donors in living renal transplantation with laparoscope

目的观察高容量血液稀释联合硝酸甘油容量调控对活体肾移植供肾者全身氧代谢的影响。方法选择在全麻腹腔镜下行肾脏切除术的健康志愿捐肾者12例，诱导前15min至肾动脉阻断时连续输注预设量4％琥珀酰明胶及乳酸林格氏液行高容量血液稀释，目标稀释值红细胞压积（Hct）为25％；同时微量泵输注硝酸甘油，维持平均动脉压（MAP）在基础值±25％范围内。分别于入室时（T0）、气腹时（T1）、肾动脉阻断前15min（T2）肾动脉阻断时（B）、阻断后30min（T4）、60min（T5）测定并记录Hct、心输出量（CO）、氧供（DO2）、氧耗（VO2）、氧摄取率（ERO2）、血乳酸（Lac）、中心静脉血氧饱和度（ScvO2）和胃黏膜内pH值（ipH）、胃黏膜内动脉血二氧化碳分压（PgCO2）、胃黏膜内动脉血二氧化碳分压与动脉血二氧化碳分压差（Ps-aCO2）的变化。结果高容量血液稀释及硝酸甘油容量调控后，Hct从42．7％±1．9％下降到25．7％±1，1％（P〈0．05）；CVP值逐渐升高，与基础值比较差异有统计学意义（P〈0．05）；DO2、CO在T1有所下降，T2-4则均高于T1，T3与T1比较差异有统计学意义（P〈0．05）；各时点VO2均下降，但各时点差异无统计学意义（P〉0．05）；ScvO2有下降趋势，ERO2、Lac有上升趋势，但各时点差异均无统计学意义（P〉0．05）；ipH有所下降，PgCO2于T1后有所升高，T3与T0比较差异有统计学意义（P〈0．05）。结论腹腔镜活体肾移植供体肾切除术中实施容量调控，供肾灌注良好，供肾者全身氧代谢稳定、内脏氧合良好，未见明显无氧代谢。

Objective To investigate the effects of capacity control on oxygen metabolism of donors in living renal transplantation using laparoscopy. Methods Hypervolemic hemodilution （HHD） was performed with continuous infusion of 4% succinylated gelatin（SG） and lactated Ringer＇s solution（RL） from 15 min before anesthesia induction to renal artery interruption to decrease Hct to the level of 25% in 12 healthy donors for living renal transplantation. Meanwhile, micro-pump infusion of nitroglycerin was administered to maintain MAP change within the range of 4- 25% of base value. Hct, CO, DO2, VO2, ERO2, Lae, ScvO2, ipH, PgCO2, Pg-aCO2 were recorded or measured before anesthesia （T0）, at the beginning of aeroperitonia （T1）, 15 min before renal artery interruption（T2）, at the start of renal artery interruption（T3）, 30 min（T4） and 60 min（T5） after renal artery interruption. Results After hypervolemic hemodilution and control hypotension with nitroglycerin, Hct went down from （42.7 ± 1.9） % to （25.7 ± 1.1 ） %, and CVP increased gradually（P〈0.05 ）. DO2 and CO decreased at T1, and increased later, with significance between T3 and T1（P〈0.05 ）. There was no significant difference in VO2, ScvO2, ERO2 and Lac among time-points, ipH decreased slightly and PgCO2 increased after TI, reaching a significant level at T3 （P〈0.05）. Conelusion Implementation of capacity control improves donor＇s renal perfusion, maintains a stable oxygen metabolism with more efficient organ oxygenation, without anaerobic metabolism.