Cavaleri Marco, Veroux Massimiliano, Palermo Filippo, Vasile Francesco, Mineri Mirko, Palumbo Joseph, Salemi Lorenzo, Astuto Marinella, Murabito Paolo
Department of Anaesthesia and Intensive Care, "Sant' Elia" Hospital, via L.Russo 6, 93100 Caltanissetta, Italy.
Vascular Surgery and Organ Transplant Unit, Department of Medical and Surgical Sciences and Advanced technologies "G F Ingrassia", University Hospital "G.Rodolico", University of Catania, via Santa Sofia 78, 95123 Catania, Italy.
J Clin Med. 2019 Jan 11;8(1):80. doi: 10.3390/jcm8010080.
Kidney transplantation is considered the first-choice therapy in end-stage renal disease (ESRD) patients. Despite recent improvements in terms of outcomes and graft survival in recipients, postoperative complications still concern the health-care providers involved in the management of those patients. Particularly challenging are cardiovascular complications. Perioperative goal-directed fluid-therapy (PGDT) and hemodynamic optimization are widely used in high-risk surgical patients and are associated with a significant reduction in postoperative complication rates and length of stay (LOS). The aim of this work is to compare the effects of perioperative goal-directed therapy (PGDT) with conventional fluid therapy (CFT) and to determine whether there are any differences in major postoperative complications rates and delayed graft function (DGF) outcomes.
Prospective study with historical controls. Two groups, a PGDT and a CFT group, were used: The stroke volume (SV) optimization protocol was applied for the PGDT group throughout the procedure. Conventional fluid therapy with fluids titration at a central venous pressure (CVP) of 8⁻12 mmHg and mean arterial pressure (MAP) >80 mmHg was applied to the control group. Postoperative data collection including vital signs, weight, urinary output, serum creatinine, blood urea nitrogen, serum potassium, and assessment of volemic status and the signs and symptoms of major postoperative complications occurred at 24 h, 72 h, 7 days, and 30 days after transplantation.
Among the 66 patients enrolled (33 for each group) similar physical characteristics were proved. Good functional recovery was evident in 92% of the CFT group, 98% of the PGDT group, and 94% of total patients. The statistical analysis showed a difference in postoperative complications as follows: Significant reduction of cardiovascular complications and DGF episodes ( < 0.05), and surgical complications ( < 0.01). There were no significant differences in pulmonary or other complications.
PGDT and SV optimization effectively influenced the rate of major postoperative complications, reducing the overall morbidity and thus the mortality in patients receiving kidney transplantation.
肾移植被认为是终末期肾病（ESRD）患者的首选治疗方法。尽管近年来受者的治疗效果和移植物存活率有所改善，但术后并发症仍是参与这些患者管理的医护人员所关注的问题。心血管并发症尤其具有挑战性。围手术期目标导向液体治疗（PGDT）和血流动力学优化在高危手术患者中广泛应用，并与术后并发症发生率和住院时间（LOS）的显著降低相关。本研究的目的是比较围手术期目标导向治疗（PGDT）与传统液体治疗（CFT）的效果，并确定术后主要并发症发生率和移植肾功能延迟恢复（DGF）结果是否存在差异。
采用历史对照的前瞻性研究。使用了两组，即PGDT组和CFT组：PGDT组在整个手术过程中应用每搏输出量（SV）优化方案。对照组采用传统液体治疗，将液体滴定至中心静脉压（CVP）为8⁻12 mmHg且平均动脉压（MAP）>80 mmHg。术后数据收集包括生命体征、体重、尿量、血清肌酐、血尿素氮、血清钾，以及在移植后24小时、72小时、7天和30天对容量状态和术后主要并发症的体征和症状进行评估。
在纳入的66例患者中（每组33例），证实了相似的身体特征。CFT组92%、PGDT组98%以及所有患者的94%功能恢复良好。统计分析显示术后并发症存在差异如下：心血管并发症和DGF发作显著减少（<0.05），手术并发症显著减少（<0.01）。肺部或其他并发症无显著差异。
PGDT和SV优化有效地影响了术后主要并发症的发生率，降低了接受肾移植患者的总体发病率，从而降低了死亡率。
