加速康复外科在肾移植术后静脉补液中的应用

目的探讨加速康复外科(ERAS)在肾移植术后静脉补液中的应用。 方法回顾性分析陆军军医大学第一附属医院124例肾移植受者临床资料。根据肾移植术后多尿期每24小时静脉补液量分为3组，A组每24小时静脉补液量2 500～<4 000 mL，术后6 h进食流质；B组每24小时补液量4 000～6 000 mL，肛门排气后进食；C组每24小时补液量>6 000 mL，肛门排气后进食。采用单因素方差分析比较3组受者术后1周中心静脉压(CVP)、心率、血压、尿量和血糖以及平均特护时间、平均住院日和术后1个月血清肌酐。采用χ²检验比较3组受者性别、供肾类型以及术后高血糖、伤口延迟愈合和移植肾功能延迟恢复(DGF)发生率。P<0.05为差异有统计学意义。 结果A、B和C组受者术后1个月血清肌酐分别为(110±23)、(114±22)和(118±22)μmol/L，差异无统计学意义(F＝1.19，P>0.05)。A组受者术后1周CVP、收缩压、尿量和血糖均低于B、C组(P均<0.05)，平均特护时间和平均住院日均短于B、C组(P均<0.05)。3组受者术后高血糖和DGF发生率差异均无统计学意义(χ²＝4.581和0.404，P均>0.05)，A组受者伤口愈合延迟发生率低于C组(χ²＝7.303，P<0.017)。仅C组1例受者因心力衰竭和肺水肿死亡。 结论ERAS适用于肾移植受者术后静脉补液策略，鼓励受者尽早饮水进食，在保证血压正常或偏高的情况下，适当减少静脉补液量，有利于减少并发症，促进受者恢复。

Application of enhanced recovery after surgery in intravenous fluid infusion after renal transplantation

ObjectiveTo explore the application of enhanced recovery after surgery (ERAS) in intravenous fluid infusion after renal transplantation. MethodsThe clinical data of 124 renal transplantation recipients in the First Hospital Affiliated to Army Medical University were retrospectively analyzed. The recipients were divided into group A, group B and group C. The 24-hour intravenous fluid infusion was 2 500 -<4 000 mL in group A, and the recipients took fluids 6 hours after the surgery. The 24-hour intravenous fluid infusion was 4 000-6 000 mL in group B, and the recipients took fluids after anus exhaust. The 24-hour intravenous fluid infusion was more than 6 000 mL in group C, and the recipients took fluids after anus exhaust. The indexes between the 3 groups including central venous pressure (CVP), heart rate, blood pressure, urine volume and blood glucose 1 week after renal transplantation, and serum creatinine 1 month after renal transplantation, and the mean time in intensive care unit and average length of stay were compared with one-way analysis of variance. The gender of recipients, type of donor kidney, and the incidence of hyperglycemia, delayed wound healing and delayed graft function (DGF) after transplantation between the 3 groups were compared with chi-square test. ResultsThe serum creatinine of the recipients between the 3 groups 1 month after transplantation were (110±23), (114±22) and (118±22) μmol/L respectively, which had no statistic difference (F=1.19, P>0.05). The CVP, systolic pressure, urine volume and blood glucose of the recipients in group A 1 week after transplantation were all lower than group B and C (P all<0.05). The mean time in intensive care unit and average length of stay of recipients in group A were shorter than group B and C (P all<0.05). No statistic difference were found for the incidence of hyperglycaemia and DGF between the 3 groups (χ²=4.581 and 0.404, P all >0.05). The incidence of delayed wound healing of group A was lower than group C (χ²=7.303, P<0.017). Only 1 recipient in group C died of heart failure and pneumonedema. ConclusionsERAS was applied to recipients after renal transplantation. Taking fluids as soon as possible and reducing the amount of infusion in the situation of normotension or slight hypertension were conducive to reduce postoperative complications, and is beneficial to postoperative recovery.