Abstract:

Objective To investigate the possibility of stroke volume variation （SVV）in guiding intraoperative volume management of renal transplantation which used the donor after cardial death （DCD）. Methods 60 patients scheduled for DCD renal transplantation in Tianjin First Center Hospital fromSeptember 2013 to June 2014 were enrolled and randomly divided into two groups ：30 patients in SVV-guided group and 30 patients in central venous pressure（CVP）-guided group. Electrocardiograph（ECG），pulse oxygen saturation（SpO2），invasive arterial blood pressure and CVP were monitored during the operation in two groups. In addition，SVV and cardiac output（CO）were monitored by FloTrac/Vigileo in SVV-guided group. Ringer's solution or polygeline were given〔2-5 ml/（kg·h）〕. In CVP-guided group，in accordance with the rehydration principleof Miller's Anesthesia（seventh edition），we maintained CVP within the range of 10-15 mmHg by regulating the infusion speed. Dynamic parameters，duration of operation，blood loss，infusion volume，inotropic medicines used intraoperatively and their dosage were monitored intraoperative. The time of seeing urine，intraoperative urinary volume，postoperative 24 h urinary volume，postoperative complication，postoperative ICU stay time，renal allograft function and postoperative hospital stay in two groups were also recorded. Results No significant difference was observed between patients during hospitalization and the survival rate of renal allograft. The dynamic parametersof SVV-guided group was more stable，while the infusion volume and postoperative ICU residence time were less than CVP-guided group〔infusion volume（ml）：3 327±205 vs. 3 550±229，P ＜ 0.01，ICU residence stay（h）：6.4±2.3 vs. 18.1±2.7，P ＜ 0.05〕. There were no significant differences in two groups of patients with intraoperative urinary volume，postoperative 24h urinary volume，postoperative adverse events，renal allograft function and postoperative hospital stay. Conclusion Compare with CVP，SVV can reflect circulatory volume status more accurately and predict fluid responsiveness of renal transplantation patients. SVV can conduct intraoperative fluidvolume for renal transplantation patients，reduce intraoperative infusion volume and postoperative ICU residence time.

摘要：

目的 探讨每搏量变异率（SVV）指导心脏死亡器官捐献（DCD）肾移植患者术中容量管理的可行性。方法 选择 2013 年 9 月至 2014 年 6 月在天津市第一中心医院行 DCD 肾移植手术患者 60 例，随机分为中心静脉压（CVP）组和 SVV 组各 30 例。两组患者常规行心电图、脉搏血氧饱和度（SpO2）、有创动脉血压、CVP 监测，SVV 组另外通过 FloTrac/Vigileo 监测 SVV、心排血量（CO）等参数。患者术中全 程乳酸林格液或聚明胶肽 2 ～ 5 ml/（kg·h）维持输液 ；CVP 组遵照《米勒麻醉学》（第 7 版）补液原则，通过调控输液速度控制 CVP 在 10 ～ 15 mmHg。记录术中患者血流动力学指标、手术时间、失血量、输液量、血管活性药物使用情况。比较两组患者见尿时间、术中尿量、术后 24 小时尿量、术后并发症、重症监护病房（ICU）停留时间、移植肾脏功能恢复情况以及术后住院时间。结果 两组患者移植肾脏成活率、肾功能恢复情况、术中尿量、术后 24 小时尿量、术后并发症、移植肾脏功能恢复情况以及术后住院时间未见统计学差异。与 CVP 组相比，SVV 组患者术中血流动力学指标更加平稳，液体输注量显著减少（ml ：3 327±205 比 3 550±229，P ＜ 0.01），术后 ICU 停留时间少于 CVP 组（h：16.4±2.3 比 18.1±2.7，P ＜ 0.05）。 结论 SVV 较 CVP 可以更准确地反映肾移植患者术中循环容量状态，且可以预测液体反应性可以减少术中液体输入量、缩短患者术后 ICU 停留时间。