Flotrac／Vigileo 指导的目标导向液体治疗在肾移植术中的应用

摘要

目的：探讨Flotrac／Vigileo指导的目标导向液体治疗在肾移植术中的应用效果。方法行肾移植患者40例，随机分为A、B两组，其中A组为Flotrac／Vigileo指导，B组为常规中心静脉压（ CVP）指导。记录患者术前（T0）、肾动脉开放时（T1）两组平均动脉压（MAP）、心率（HR）、CVP、心输出指数（CI）、每搏变异度（SVV），统计患者术中出入量；监测患者术前、手术结束时的乳酸，采集静脉血标本测定患者术前及术后3d的肾功能指标———肌酐。结果肾动脉开放时（T1）A组MAP、CVP、CI高于B组，SVV低于B组（P＜0.05）。术毕乳酸A组低于B组（P＜0.05）。 A、B两组术后肌酐较术前明显改善，术后第2、3天A组肌酐改善优于B组（P＜0.05）。结论在肾移植术中应用Flotrac／Vigileo指导的目标导向液体治疗能显著增加肾的灌注，加速肾功能的恢复。%Objective To investigate effacy of goal -directed fluid therapy based on Flotrac/Vigileo in renal transplantation.Methods Forty patients scheduled for renal transplantation were randomly divided into two groups.Fluid therapy in Group A was guided by Flotrac/Vigileo, while Group B guided by central venous pressure( CVP) .mean arterial pressure(MAP), heart rate(HR), CVP, cardiac index(CI) and stroke volume variation(SVV) were recorded at the time before surgery(T0), and at opening of renal artery(T1).Fluid infusion and output,as well as levels of lactic acid before and at the end of surgery were also recorded.Venous blood samples were collected to measure serum creatinine before and 3 days after surgery.Results The MAP, CVP, CI in Group A were higher than in Group B at T1, while SVV was lower than in Group B at T1(P<0.05).At the end of surgery, the level of lactic acid in Group A were lower than in Group B (P<0.05).Postoperative levels of creatinine decreased significantly in both groups compared with preoperative levels. Decrease in creatinine in Group A was more significant than in Group B on 2 days and 3 days postoperatively.Conclusion Application goal-directed fluid therapy guided by Flotrac/Vigileo in renal transplantation can significantly increase re-nal perfusion and accelerate the recovery of renal function.