氢吗啡酮术后镇痛对DCD肾移植患者术后早期DGF和排斥反应的影响

The effect of hydromorphone for postoperative analgesia on early postoperative DGF and rejection in patients with renal transplantation from DCD

目的探讨氢吗啡酮术后镇痛对心脏死亡器官捐献(DCD)肾移植患者术后早期移植肾功能延迟恢复(DGF)和排斥反应的影响。方法回顾性分析解放军联勤保障部队第九二四医院自2021年1—12月行DCD肾移植术患者68例的资料,其中术后镇痛使用氢吗啡酮32例(A组)、非氢吗啡酮36例(B组)。通过回顾病例资料,统计术后不良反应发生率、血清胱抑素C(Cys-C)、C反应蛋白(CRP)、血清肌酐及其下降程度并进行比较。结果A组术后镇痛不良反应发生率、术后第3天CRP低于B组,差异有统计学意义(P<0.05);A组Cys-C术后第1天到术后第2天下降程度、血清肌酐术后第1天到术后第2天下降程度、CRP术后第2天到术后第3天下降程度高于B组,差异有统计学意义(P<0.05)。A组和B组的手术时间、出血量、术后同时段Cys-C、血清肌酐比较,差异无统计学意义(P>0.05)。结论氢吗啡酮用于DCD肾移植术后镇痛,能增加DCD肾移植患者术后早期Cys-C下降程度、肌酐下降程度,下调CRP,减少对移植肾的损伤,减少DGF发生的可能,预防排斥反应,更利于DCD移植肾功能的恢复。

Objective To explore the effect of hydromorphone for postoperative analgesia on early postoperative delayed graft function(DGF)and rejection in patients with renal transplantation from donation after cardiac death(DCD).Methods A retrospective analysis was conducted on the data of 68 patients undergoing renal transplantation from DCD from January to December 2021 at the 924th Hospital of PLA Joint Logistics Support Force.Among them,32 patients received postoperative analgesia with hydromorphone(Group A)and 36 patients received postoperative analgesia with non-hydromorphone(Group B).By reviewing case data,the incidence of postoperative adverse reactions,serum cystatin C(Cys-C),C-reactive protein(CRP),and serum creatinine and their degree of decrease were statistically analyzed and compared.Results The incidence of adverse reactions of postoperative analgesia and CRP on the 3rd day after surgery in Group A were lower than those in Group B,with statistically significant differences(P<0.05).The degrees of decrease in Cys-C and serum creatinine from postoperative day 1 to postoperative day 2,and CRP from postoperative day 2 to postoperative day 3 in Group A were significantly higher than those in Group B,with statistically significant differences(P<0.05).There were no statistically significant differences between Group A and Group B in surgical time,bleeding volume,and Cys-C and serum creatinine levels at the same period after surgery(P>0.05).Conclusion Hydromorphone used for postoperative analgesia in patients with renal transplantation from DCD could increase the degree of decrease in Cys-C and creatinine levels in the early postoperative period,downregulate CRP,reduce damage to the transplanted kidney,reduce the possibility of DGF,prevent rejection,and facilitate the recovery of the function of the transplanted kidney from DCD.