CAJ | 학술논문

目的探讨去甲肾上腺素对原位肝移植术患者肾功能的影响.方法择期行原位肝移植术的晚期肝硬化患者40例,年龄40～60岁,体重53～78 kg,ASAⅢ级或Ⅳ级,随机分为2组(n=20):去甲肾上腺素组(N组)术中静脉输注去甲肾上腺素,初始输注速率为0.01～0.02 μg·kg-1 min-1;多巴胺组(D组)术中静脉输注多巴胺,初始输注速率为1～2 μg·kg-1·min-1.调整无肝前期、无肝期和新肝期去甲肾上腺素输注速率分别为0.01～0.05、0.03～0.25和0.02～0.40 μg·kg-1·min-1;多巴胺输注速率分别为1～5、3～30和1～10 μg·kg-1·min-1,以维持无肝期平均动脉压(MAP)60～80 mm Hg,其他时期MAP 60～100mm Hg.分别于切皮前、切皮后1 h、无肝期30min、新肝期1 h及4 h时记录、心输出量、体循环血管阻力,计算心指数及体循环血管阻力指数,于上述各时点抽取中心静脉血,并留取尿液,测定各项肾功能指标,术后1周内测定肾功能指标.结果两组间各时点血液动力学指标比较差异无统计学意义(P＞0.05),血清胱抑素C(Cys C)、血清β2-微球蛋白(β2-MG)、血清肌酐(Cr)及血清肌酐清除率(CCr)均在正常范围内,组间及组内比较差异均无统计学意义(P＞0.05).D组于切皮后1 h时尿β2-MG高于N组(P＜0.05).两组无肝期尿量、术中总尿量、术中呋塞米用量及术后24 h尿量比较差异无统计学意义(P＞0.05).两组术后1周内各时点血清β2-MG、Cr及CCr均在正常范围内.结论原位肝移植术中静脉输注去甲肾上腺素对患者肾功能无不利影响.
목적 탐토거갑신상선소대원위간이식술환자신공능적영향.방법 택기행원위간이식술적만기간경화환자40례,년령40～60세,체중53～78 kg,ASAⅢ급혹Ⅳ급,수궤분위2조(n=20):거갑신상선소조(N조)술중정맥수주거갑신상선소,초시수주속솔위0.01～0.02 μg·kg-1 min-1;다파알조(D조)술중정맥수주다파알,초시수주속솔위1～2 μg·kg-1·min-1.조정무간전기、무간기화신간기거갑신상선소수주속솔분별위0.01～0.05、0.03～0.25화0.02～0.40 μg·kg-1·min-1;다파알수주속솔분별위1～5、3～30화1～10 μg·kg-1·min-1,이유지무간기평균동맥압(MAP)60～80 mm Hg,기타시기MAP 60～100mm Hg.분별우절피전、절피후1 h、무간기30min、신간기1 h급4 h시기록、심수출량、체순배혈관조력,계산심지수급체순배혈관조력지수,우상술각시점추취중심정맥혈,병류취뇨액,측정각항신공능지표,술후1주내측정신공능지표.결과 량조간각시점혈액동역학지표비교차이무통계학의의(P＞0.05),혈청광억소C(Cys C)、혈청β2-미구단백(β2-MG)、혈청기항(Cr)급혈청기항청제솔(CCr)균재정상범위내,조간급조내비교차이균무통계학의의(P＞0.05).D조우절피후1 h시뇨β2-MG고우N조(P＜0.05).량조무간기뇨량、술중총뇨량、술중부새미용량급술후24 h뇨량비교차이무통계학의의(P＞0.05).량조술후1주내각시점혈청β2-MG、Cr급CCr균재정상범위내.결론 원위간이식술중정맥수주거갑신상선소대환자신공능무불리영향.
Objective To evaluate the effects of norepinephrine on renal function in patients undergoing orthotepic liver transplantation (OLT) .Methods Forty ASA III or IV patients aged 40-60 yr weighing 53-78 kg undergoing OLT were randomly allocated to one of two groups of 20 patients each: norepinephrine group (N) and dopamine group (D).In group N norepinephrine was continuously infused during operation.The initial infusion rate was 0.01-0.02 μg·kg-1·min-1.In group D dopamine was continuously infused at the initial infusion rate of 1-2 μg·kg-1·min-1.The infusion rates were adjusted to maintain MAP between 60-80 mm Hg during the anhepatic phase and between 60-100 mm Hg during the other two phases.Cardiac output (CO),cardiac index (CI),systemic vascular resistance (.SVR),systemic vascular resistance index (SVRI) and variables of renal function (serum cystatin C,serum creatinine,serum β2-mieroglobulin) were measured immediately before incision (T1,baseline),at 1 h after incision (T2),30 min of anbepatic phase (T3),at 1 h and 4 h of neehepatic phase.Results There were no significant differences in bemedynamic variables at all time points between the 2 groups.Serum cystatin C,serum creatinine and serum β2-microglobulin concentrations were all within normal range at all time paints in both groups.Urine β2-microglobulin in group D was significantly higher than that in group N at T2 (P＜0.05).There was no significant difference in urine output during operation and on the first day after operation and in the amount of furosemide used during operation between the 2 groups.The serum β2-microglobulin,serum creatinine and creatinine clearance were all within normal range during the first week after operation in both groups.Conclusion Norepinephrine infusion has no deleterious effects on renal function in patients undergoing OLT.