每搏变异度指导肾移植术中输液对患者早期预后的影响

Influence of the infusion management on the early prognosis of patients with kidney transplantation guided by stroke volume variation monitoring

目的观察每博变异度(stroke volume variation,SVV)在指导肾移植手术中输液管理的临床效果。方法全麻下行同种异体肾移植术40例,随机分为观察组和对照组,每组20例。观察组在SVV指导下进行输液治疗,对照组采用经典4-2-1液体疗法。观察两组患者围术期并发症及术后早期恢复情况。结果与对照组相比,观察组围术期总输液量明显减少(P<0.01),但两组术中呼吸循环并发症、主要血气指标、出血量、尿量、术后拔管时间、离室时间、住院时间、术后14d内恢复质量评分和30d内肺部感染、胸腔积液、肺水肿、心功能衰竭、淋巴瘘及重度贫血发生率的比较差异无统计学意义(P>0.05)。结论肾移植术中采用SVV指导容量管理可明显减少术中输液量,但并不能改善患者早期预后,传统输液策略仍可安全用于肾移植术。

Objective To observe the influence of the infusion management on the early prognosis of patients with kidney transplantation guided by stroke volume variation(SVV)monitoring.Methods Forty ASA GradeⅢorⅣpatients received kidney transplantation under general anesthesia were included,and randomly divided into observation group and control group with twenty cases each.The transfusion program was guided by SVV in observation group,and classic 4-2-1 fluid therapy was administered in control group.The perioperative complications,and early recovery status after surgery were observed.Results Compared with the control group,the total infusion volume in observation group was significantly reduced(P<0.01),but there were no significant differences in the respiratory and circulatory complications,main blood gas analysis parameters,blood loss,urine volume,post-operative extubation time,departure time,hospital stays,quality of recovery within 14 days or post-operative complications within 30 days between the 2 groups(P>0.05).Conclusion The fluid therapy guided by SVV during kidney transplantation can significantly reduce the intra-operative infusion volume,but it cannot improve patients′early prognosis.The traditional infusion strategy is still safe for kidney transplantation.