去甲肾上腺素对原位肝移植术患者肾功能的影响

目的 探讨去甲肾上腺素对原位肝移植术患者肾功能的影响.方法 择期行原位肝移植术的晚期肝硬化患者40例,年龄40～60岁,体重53～78 kg,ASAⅢ级或Ⅳ级,随机分为2组(n=20):去甲肾上腺素组(N组)术中静脉输注去甲肾上腺素,初始输注速率为0.01～0.02 μg·kg-1 min-1;多巴胺组(D组)术中静脉输注多巴胺,初始输注速率为1～2 μg·kg-1·min-1.调整无肝前期、无肝期和新肝期去甲肾上腺素输注速率分别为0.01～0.05、0.03～0.25和0.02～0.40 μg·kg-1·min-1;多巴胺输注速率分别为1～5、3～30和1～10 μg·kg-1·min-1,以维持无肝期平均动脉压(MAP)60～80 mm Hg,其他时期MAP 60～100mm Hg.分别于切皮前、切皮后1 h、无肝期30min、新肝期1 h及4 h时记录、心输出量、体循环血管阻力,计算心指数及体循环血管阻力指数,于上述各时点抽取中心静脉血,并留取尿液,测定各项肾功能指标,术后1周内测定肾功能指标.结果 两组间各时点血液动力学指标比较差异无统计学意义(P＞0.05),血清胱抑素C(Cys C)、血清β2-微球蛋白(β2-MG)、血清肌酐(Cr)及血清肌酐清除率(CCr)均在正常范围内,组间及组内比较差异均无统计学意义(P＞0.05).D组于切皮后1 h时尿β2-MG高于N组(P＜0.05).两组无肝期尿量、术中总尿量、术中呋塞米用量及术后24 h尿量比较差异无统计学意义(P＞0.05).两组术后1周内各时点血清β2-MG、Cr及CCr均在正常范围内.结论 原位肝移植术中静脉输注去甲肾上腺素对患者肾功能无不利影响.

Effects of norepinephrine on renal function in patients undergoing orthotopic liver transplantation

Objective To evaluate the effects of norepinephrine on renal function in patients undergoing orthotepic liver transplantation (OLT) .Methods Forty ASA III or IV patients aged 40-60 yr weighing 53-78 kg undergoing OLT were randomly allocated to one of two groups of 20 patients each: norepinephrine group (N) and dopamine group (D).In group N norepinephrine was continuously infused during operation.The initial infusion rate was 0.01-0.02 μg·kg-1·min-1.In group D dopamine was continuously infused at the initial infusion rate of 1-2 μg·kg-1·min-1.The infusion rates were adjusted to maintain MAP between 60-80 mm Hg during the anhepatic phase and between 60-100 mm Hg during the other two phases.Cardiac output (CO),cardiac index (CI),systemic vascular resistance (.SVR),systemic vascular resistance index (SVRI) and variables of renal function (serum cystatin C,serum creatinine,serum β2-mieroglobulin) were measured immediately before incision (T1,baseline),at 1 h after incision (T2),30 min of anbepatic phase (T3),at 1 h and 4 h of neehepatic phase.Results There were no significant differences in bemedynamic variables at all time points between the 2 groups.Serum cystatin C,serum creatinine and serum β2-microglobulin concentrations were all within normal range at all time paints in both groups.Urine β2-microglobulin in group D was significantly higher than that in group N at T2 (P＜0.05).There was no significant difference in urine output during operation and on the first day after operation and in the amount of furosemide used during operation between the 2 groups.The serum β2-microglobulin,serum creatinine and creatinine clearance were all within normal range during the first week after operation in both groups.Conclusion Norepinephrine infusion has no deleterious effects on renal function in patients undergoing OLT.