肾移植患者围术期麻醉管理：40例资料回顾

背景：从肾移植患者围术期血生化检测结果可以看到，一些酸碱指标及生化指标的变化可能与血液稀释有关。目的：通过监测肾移植患者围术期血流动力学的变化以及电解质、血生化的改变，麻醉药物使用情况，探讨肾移植患者理想的麻醉管理方法。方法：分析40例肾移植患者麻醉前、肾动脉血流开放前、血流开放后10 min、手术结束时(T4)各时点平均动脉压、中心静脉压、心率、电解质、血糖和血气参数的变化。结果与结论：与肾移植患者麻醉前比较，血流开放后10 min平均动脉压、中心静脉压、pH、HCO3-、BE显著降低(P < 0.01)，K+和葡萄糖明显增加(P < 0.01)。与肾动脉血流开放前比较，血流开放后10 min平均动脉压、葡萄糖、pH、HCO3-、BE明显降低而心率明显增高(P < 0.05)。说明充分的移植前准备，合理的麻醉药物选择，以及围术期的循环、呼吸及水电解质酸碱平衡的维持是肾移植术全身麻醉成功的关键。

Perioperative anesthesia management in patients undergoing allogenic renal transplantation: A review of data from 40 cases

BACKGROUND: Results of blood and blood glucose in patients undergoing allogenic renal transplantation show that changes of Na+, Cl-, Hct, Hb may be related to the blood dilution. OBJECTIVE: To investigate an ideal anesthesia management in patients undergoing allogenic renal transplantation by monitoring the perioperative change of hemodynamics, electrolytes and biochemistry and anesthetic drug application. METHODS: Mean arterial blood pressure (MAP), central venous pressure (CVP) and heart rate (HR), electrolytes and biochemistry were monitored and analyzed in 40 patients undergoing renal transplantation before anesthesia, before opening of renal artery, 10 minutes after opening renal artery and at the end of surgery. RESULTS AND CONCLUSION: Compared with before anesthesia, MAP, CVP, pH, HCO3- and BE decreased significantly (P < 0.01), and K+ and glucose levels increased significantly (P < 0.01) at 10 minutes after opening of renal artery. Compared with before opening of renal artery, MAP, glucose, pH, HCO3- and BE decreased significantly while HR was significantly increased at 10 minutes after opening of renal artery (P < 0.05). These findings suggest that a key to successful general anesthesia of renal transplantation involves sufficient preoperative preparation, rational anesthetic drug selection and the maintenance of perioperative circulation, breathing, and water-electrolyte and acid-base balance.