肝脏移植围手术期肾脏功能的维护

目的 探讨肝移植病人围手术期肾功能损害的相关因素及防治策略。方法 观察118例原位肝移植病人围手术期肾功能变化情况。术前保证肾脏的有效灌流量，清除体内肾毒性物质；术中尽量减少血压波动，缩短无肝期时间，必要时采取体外转流；术后避免应用肾毒性药物，24h内根据血压情况应用小剂量多巴胺或硝酸甘油，以有效保护肾功能。结果 本组118例病人中21例术后第1天发生少尿，在应用大剂量呋塞米情况下尿量仍少于1000ml／24h，停用更昔洛韦和氟康唑等药物后，其中16例病人在2～4d内尿量恢复到1000ml／24h以上，21例病人中死亡6例，占总死亡人数的46．2％（6／13），所有105例康复病人出院时肌酐均正常。结论 有效保护肾功能是提高肝脏移植手术成功率的重要措施。

Protection of renal function during perioperative period of liver transplantation

Objective To explore the related factors and strategy of prevention and treatment of renal dysfunction during the perioperative period of liver transplantation. Methods The changes of urine volume was observed in 118 undergoing liver transplantation during the perioperative period. Maintenance of renal perfusion and clearance of the nephrotoxic substances were performed preoperatively. Stable blood pressure and short anhepatic phase were maintained during the operation. Vitro circulation was performed in some patients. After the operation, the drugs were carefully used to avoid renal damage. Low-dose dopamine and nitroglycerin were used in the first 24 h after the liver transplantation. Results Six of the 118 recipients died of acute renal failure after the liver transplantation. The urine volume was under 1000 ml in 21 patients after the liver transplantation even if large dose of furosemide was given. In 13 of the 21 patients, the urine volume was over 1000 ml in the fourth 24 h when the intravenous administration of ganciclovir and fluconazole was stopped. A total of 105 patients with normal level of creatinine were discharged from our hospital. Conclusions Protection of renal function is essential for promoting the successful rate of liver transplantation.