术中血压对同种异体肾移植患者术后肾功能恢复的影响

摘要

Objective We investigated the influence of intraoperative blood pressure on graft function in allograft re-nal transplantation in order to further optimize the anesthetic management of renal transplantation and reduce the inci-dence of postoperative complications.Methods This retrospective study included 54 cases of allograft renal transplan-tation patients in January 2008 to August 2013.The functional recovery of renal transplants can be divided into two groups (n=27):delayed graft function (DGF)and immediate graft function (IGF),two patients were excluded in DGF group.The systolic pressure,diastolic pressure and mean arterial pressure,heart rate were compared between two groups in four time points:preoperative status,the time of into operating room,the time of reperfusion,and the time of leaving the operating room.Results There is no significant difference between two groups in age,sex,height and type of dialysis (P>0.05);however,the duration of dialysis of the patients with DGF is longer than those with IGF(P<0.05).The comparison of systolic pressure,diastolic pressure and mean arterial pressure,heart rate were not significant between two groups in four time points:preoperative status,the time of into operating room,the time of reperfusion and the time of leaving the operating room(P>0.05).Conclusion Based on the current blood pressure management plan that intraoperative blood pressure fluctuates less than 30% of the preoperative value,the anesthesia management of al-lograft renal transplantation surgery is safe and reasonable.There was no connection between postoperative renal func-tion recovery and intraoperative blood pressure.%目的：探讨术中血压对行同种异体肾移植患者术后肾功能恢复的影响，以期进一步优化肾移植手术麻醉管理模式，减少围术期并发症。方法本回顾性研究纳入2008年1月至2013年8月期间行同种异体肾移植手术患者54例，根据术后肾功能恢复情况分为肾功能延迟恢复组（DGF组）与肾功能立即恢复组（IFG组），每组27例，其中DGF组排除2例，余25例。对两组患者在术前基础状态（T0）、入室平静后（T1）、肾动脉开放（T2）、出室（T3）四个时间点收缩压、舒张压、平均动脉压、心率，进行比较。结果两组患者术前一般情况比较，年龄、性别、身高、透析类型相比，差异无统计学意义（P＞0．05）；DGF组患者透析时间较 IGF组长（P＜0．05）。两组患者术前基础状态（T0）、入室平静后（T1）、肾动脉开放（T2）、出室（T3）四个时间点收缩压、舒张压、平均动脉压、心率比较，差异无统计学意义（P＞0．05）。结论按照现行血压控制方案，即术中将血压波动控制在术前基础值的±30％以内，管理同种异体肾移植手术麻醉是安全合理的，术后肾功能恢复情况与术中血压无必然联系。