肝移植术中呼气末二氧化碳下降与术后发生急性肾损伤的关系

The relationship between the decrease of end expiratory carbon dioxide during liver transplantation and the occurrence of acute kidney injury after surgery

目的探讨肝移植术中呼气末二氧化碳(etCO_(2))是否与肝移植术后发生急性肾损伤(AKI)相关。方法回顾性收集83例行经典式同种异体原位肝移植手术患者的临床资料,根据术后48 h内血清肌酐水平变化将患者分为AKI组和非AKI组,并分析组间基础资料、术中etCO_(2)下降率[ΔetCO_(2)(%)]及术后肌酐值等差异。结果83例肝移植患者术后48 h内AKI发生率为56.6%(47/83)。AKI组男性患者占比更多(P=0.003),AKI组患者的无肝期ΔetCO_(2)(%)高于非AKI患者[(0.26±0.08)%vs(0.22±0.07)%,P=0.024]。两组无肝前期、夹闭IVC时、新肝期ΔetCO_(2)(%)差异均无统计学意义(均P>0.05)。AKI组术后第7天肌酐值显著高于非AKI组[68.7(55.4,92.6)μmol/L vs 52.7(44.1,69.3)μmol/L,P<0.001],3个月随访时AKI组43例(91.5%)患者的肌酐恢复正常。结论肝移植术中无肝期ΔetCO_(2)(%)下降幅度一定程度上反映了术中循环的剧烈波动,可能与术后48 h内发生AKI有关。

Objective To investigate whether end-tidal carbon dioxide(etCO_(2))is associated with acute kidney injury(AKI)after liver transplantation.Methods Clinical data of 83 patients undergoing classic allogeneic liver transplantation were retrospectively collected.Patients were divided into AKI group and non AKI group based on changes in serum creatinine levels within 48 hours after surgery,and differences in baseline data,intraoperative etCO_(2) decrease rate[ΔetCO_(2)(%)],and postoperative creatinine values were analyzed between the groups.Results The incidence of AKI within 48 hours after liver transplantation in 83 patients was 56.6%(47/83).The proportion of male patients in the AKI group was higher(P=0.003),and the ΔetCO_(2)(%)in the anhepatic phase of AKI group patients was higher than that of non AKI patients[(0.26±0.08)%vs(0.22±0.07)%,P=0.024].There was no statistically significant difference in ΔetCO_(2)(%)between the two groups during pre liver,inferior vena cava(IVC)occlusion,and new liver phase(all P>0.05).On the 7th day after surgery,the creatinine value in the AKI group was significantly higher than that in the non AKI group[68.7(55.4,92.6)]μmol/L vs [52.7(44.1,69.3)μmol/L,P<0.001],at a 3-month follow-up,creatinine levels in 43 patients(91.5%)in the AKI group returned to normal.Conclusions The decrease in ΔetCO_(2)(%)during the anhepatic phase of liver transplantation reflects to some extent the severe fluctuations in circulation during the operation,which may be related to the occurrence of AKI within 48 hours after surgery.