Goyal Vipin Kumar, Gupta Priyamvada, Baj Birbal, Garg Vishnu Kumar
Department of Anaesthesiology, Critical Care and Pain Management, Mahatma Gandhi Medical College, Jaipur, Rajasthan, India.
J Anaesthesiol Clin Pharmacol. 2021 Oct-Dec;37(4):628-632. doi: 10.4103/joacp.JOACP_23_20. Epub 2022 Jan 6.
Intraoperative fluid management is important in renal transplant recipients with end-stage renal disease. Conventionally, central venous pressure (CVP) has been used to guide perioperative fluid administration but with high incidence of poor graft outcome. There is a requirement of reliable parameter to guide the fluid therapy in these patients so as to minimize the perioperative complications and improve the outcome. Hence, this study was conducted.
This prospective study included 75 patients of chronic kidney disease undergoing renal transplantation. Patients were divided into two groups. Group A (control group): Intraoperative fluids were guided by CVP; Group B: Intraoperative fluids were guided by pulse pressure variation (PPV). Primary outcome measure of this study was incidence of delayed graft functioning, i.e., need of hemodialysis within 7 days of renal transplant. Secondary outcome measures were incidence of perioperative hypotension, post-transplant pulmonary edema, tissue edema, and lactic acidosis.
Total amount of fluid before reperfusion was significantly greater in the control group ( = 0.005). However, the total amount of fluid required at the end of surgery was comparable. Delayed graft functioning was seen only in CVP group, although it was not statistically significant. The postoperative tissue edema was more in CVP group ( = 0.03). The postoperative nausea and vomiting, pulmonary edema, and mechanical ventilation were more in CVP group but not statistically significant. Increase in lactate value was more in CVP group.
Perioperative fluid guidance by PPV is better than central venous pressure in renal transplant patients.
对于终末期肾病的肾移植受者，术中液体管理至关重要。传统上，中心静脉压（CVP）一直用于指导围手术期液体输注，但移植肾预后不良的发生率较高。需要一种可靠的参数来指导这些患者的液体治疗，以尽量减少围手术期并发症并改善预后。因此，开展了本研究。
这项前瞻性研究纳入了75例接受肾移植的慢性肾脏病患者。患者分为两组。A组（对照组）：术中液体输注以CVP为指导；B组：术中液体输注以脉压变异度（PPV）为指导。本研究的主要结局指标是移植肾功能延迟恢复的发生率，即肾移植后7天内需要进行血液透析。次要结局指标是围手术期低血压、移植后肺水肿、组织水肿和乳酸酸中毒的发生率。
再灌注前对照组的液体总量显著更多（P = 0.005）。然而，手术结束时所需的液体总量相当。仅在CVP组观察到移植肾功能延迟恢复，尽管差异无统计学意义。CVP组术后组织水肿更严重（P = 0.03）。CVP组术后恶心呕吐、肺水肿和机械通气的发生率更高，但差异无统计学意义。CVP组乳酸值升高更明显。
在肾移植患者中，PPV指导围手术期液体管理优于中心静脉压。
