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气腹预处理预防腹腔镜部分肾切除术对肾功能的影响:一项双盲随机对照试验方案。

Pneumoperitoneum preconditioning for the prevention of renal function after laparoscopic partial nephrectomy: protocol for a double-blind randomised controlled trial.

机构信息

Department of Urology, Nanjing First Hospital, Nanjing Medical University, Nangjing, Jiangsu, China.

Nuclear Medicine Center, Nanjing First Hospital, Nanjing Medical University, Nangjing, Jiangsu, China.

出版信息

BMJ Open. 2020 May 26;10(5):e032002. doi: 10.1136/bmjopen-2019-032002.

DOI:10.1136/bmjopen-2019-032002
Abstract

INTRODUCTION

Renal ischaemia reperfusion injury is an inevitable pathophysiology in different clinical situations including laparoscopic partial nephrectomy (LPN), which can obviously decrease the renal function after surgery. Pneumoperitoneum preconditioning (PP) is a promising approach that can yield a protective effect on kidney, which has already been demonstrated in some animal models. The present study is designed to assess whether the PP can yield a clinical renoprotective role after LPN.

METHODS AND ANALYSIS

This study is a randomised, prospective, double-blind and parallel controlled clinical trial. Eligible participants will be patients with renal tumours and willing to choose elective LPN. Patients randomised to the treatment arm will receive PP consisted of three cycles of 5 min insufflation and 5 min desufflation before LPN, while the control arm will receive a sham operation. The primary endpoints are glomerular filtration rate and the level of serum cystatin C within 6 months after desufflation. The secondary endpoints are serum creatinine, estimated glomerular filtration rate, alanine transaminase, serum amylase, intestinal fatty acid binding protein, postoperative hospital stay, the incidence of adverse events and mortality in postoperative 6 months.

ETHICS AND DISSEMINATION

This study has been approved by the institutional ethics committee of Nanjing First Hospital. The results of this study will be reported faithfully through scientific conferences or published articles.

TRIAL REGISTRATION NUMBER

NCT03822338.

摘要

介绍

肾缺血再灌注损伤是包括腹腔镜部分肾切除术(LPN)在内的不同临床情况下不可避免的病理生理学过程,它会明显降低术后的肾功能。气腹预处理(PP)是一种很有前途的方法,可以对肾脏产生保护作用,这在一些动物模型中已经得到了证实。本研究旨在评估 PP 是否能在 LPN 后产生临床肾脏保护作用。

方法和分析

这是一项随机、前瞻性、双盲、平行对照的临床试验。符合条件的参与者将是患有肾肿瘤并愿意选择择期 LPN 的患者。随机分到治疗组的患者将接受三次 5 分钟充气和 5 分钟放气的 PP,而对照组将接受假手术。主要终点是充气后 6 个月内肾小球滤过率和血清胱抑素 C 水平。次要终点是血清肌酐、估算肾小球滤过率、丙氨酸氨基转移酶、血清淀粉酶、肠脂肪酸结合蛋白、术后住院时间、术后 6 个月内不良事件和死亡率。

伦理和传播

本研究已获得南京第一医院机构伦理委员会的批准。研究结果将通过科学会议或发表文章如实报告。

试验注册号

NCT03822338。

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本文引用的文献

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Laparoscopic Partial Nephrectomy: A Narrative Review and Comparison with Open and Robotic Partial Nephrectomy.腹腔镜下部分肾切除术:一篇叙述性综述及与开放性和机器人辅助部分肾切除术的比较
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The effects of adding ischemic preconditioning during desflurane inhalation anesthesia or propofol total intravenous anesthesia on pneumoperitoneum-induced oxidative stress.在七氟醚吸入麻醉或丙泊酚全静脉麻醉期间添加缺血预处理对气腹引起的氧化应激的影响。
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Attenuation of Oxidative Stress by Ischemic Preconditioning in an Experimental Model of Intraabdominal Hypertension.
缺血预处理对腹腔内高压实验模型氧化应激的减轻作用
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[Effects of pneumoperitoneum preconditioning on endothelial progenitor cells and renal protective mechanism in rats].[气腹预处理对大鼠内皮祖细胞及肾脏保护机制的影响]
Zhonghua Yi Xue Za Zhi. 2015 Apr 28;95(16):1248-52.
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Effects of ischemic preconditioning on the systemic and renal hemodynamic changes in renal ischemia reperfusion injury.缺血预处理对肾缺血再灌注损伤中全身及肾脏血流动力学变化的影响。
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Renal function after nephron-sparing surgery versus radical nephrectomy: results from EORTC randomized trial 30904.保肾手术与根治性肾切除术对肾功能的影响:EORTC 随机试验 30904 的结果。
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Effect of remote ischaemic preconditioning on renal protection in patients undergoing laparoscopic partial nephrectomy: a 'blinded' randomised controlled trial.远程缺血预处理对腹腔镜部分肾切除术患者肾脏保护作用的影响:一项“盲法”随机对照试验。
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The impact of ischemic preconditioning on hemodynamic, biochemical and inflammatory alterations induced by intra-abdominal hypertension: an experimental study in a porcine model.缺血预处理对腹腔内高压诱导的血流动力学、生化和炎症改变的影响:猪模型的实验研究。
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