同种异体肾移植容量治疗策略的对比分析

背景：肾移植的容量治疗策略走过了不同阶段,但尚无定论何种液体治疗策略更加合理、有效。目的：对比分析肾移植中3种不同的液体治疗策略对患者移植中血流动力学及移植后转归的影响。方法：回顾分析同种异体肾移植255例,患者根据移植中输注液体种类分为3组,胶体组(晶体+琥珀酰明胶+红细胞+白蛋白),晶体+红细胞组,晶体组。分析指标包括一般资料、围术期资料和术后随访资料。结果与结论：单纯输注晶体液虽有助于肾功能的维护,但扩容效力弱,扩容持续时间短,不利于维护肾移植中血流动力学稳定,且易导致电解质失衡,尤其不应以生理盐水为主,而应以平衡液为主。晶体液与胶体液并用有利于肾移植中血流动力学稳定,但对移植肾功能的保护作用并无优势。而以平衡液为主,必要时输血,无论在维持稳定的血流动力学方面,还是维持内环境稳定方面,以致于对术后转归的影响方面,均具有一定的优势,或许是肾移植最佳的容量治疗策略。

Comparative analysis of volume regimens for homogeneity variant kidney transplantation

BACKGROUND: The volume regimens through different stages in renal transplantation. But which liquid treatment strategy is more reasonable and effective is still unclear.OBJECTIVE: To compare three different volume regimens for kidney transplantation by observing the effect on hemodynamics and turnover.METHODS: Retrospectively analysis was done in 255 patients undergoing homogeneity variant kidney transplantation. The patients were divided into three groups according to the type of the infusion liquid: Colloids (crystalloids+succinylated gelatin+red blood cells+albumin) group, crystalloids and red blood cells group and crystalloids group. Analysis indexes included general information, perioperative data and postoperative follow-up data.RESULTS AND CONCLUSION: Although crystalloid infusion was contributed to the protection of renal function during renal transplantation, the effect of expansion was weak and the duration of expansion was short, as well as it was not conducive to maintain the stable hemodynamics, and easily led to electrolyte imbalance. The crystalloid infusion in renal transplantation should apply the equilibrium liquid mainly instead of normal saline. The combination of crystalloid and colloid infusion was conducive to stabilize the hemodynamics, but had no advantage for the protection of renal function. The equilibrium liquid was mainly used and red blood cells were infused when necessary. This volume regimen could maintain hemodynamics stable and homeostasis stable, and profit to turnover. It may be the best volume regimen for renal transplantation.