Effects of norepinephrine on intraoperative graft perfusion and postoperative graft function in living kidney transplantation
Objective To compare the effect of norepinephrine and dopamine as vasoactive agent in living kidney transplantation on intraoperative graft perfusion and graft function within seven days.Methods Ninety-four patients undergoing living-donor kidney transplantation,76 males and 18 females,aged 18-64 years,BMI 18-24 kg/m2,ASA physical status Ⅲ or Ⅳ,were selected and randomly divided into two groups using computer random number method:norepinephrine group(group N)and dopamine group(group D),47 patients in each group.After anesthesia induction,group N was treated with norepi-nephrine 0.03 mg/kg,while group D was treated with dopamine 3 mg/kg to keep the patients'MAP fluctua-ted less than 10％of the baseline.Renal artery resistance index(RI)was measured before closing the ab-dominal wall and hemodynamic indexes such as MAP,pulse pressure(PP),CVP,and arterial blood gas indexes such as pH,potassium(K+)and lactic acid(Lac)were recorded immediately before abdominal closure and 24 hours after operation.Hemodynamic parameters such as cardiac output(CO),stroke varia-bility(SVV),and vasoactive drug score(VIS)were recorded immediately before abdominal closure.RI was re-measured 24 hours after operation,and the serum creatinine(Scr),glomerular filtration rate(GFR),and the incidence of delayed recovery of graft function(DGF)within 1 day,3,5,and 7 days af-ter operation were recorded.Results There was no significant difference in MAP,PP,CVP,CO,SVV,VIS immediately before abdominal closure,and MAP,PP and CVP 24 hours after operation between the two groups.Compared with immediately before abdominal closure,K+in the two groups decreased significantly 24 hours after operation(P＜0.05),and there was no significant difference in Lac between the two groups at different time points.The RI in group N was not higher than that in group D during operation and 24 hours after operation[the lower limit of 95％confidence interval(CI)of RI was 0.087 during operation and 0.059 after operation,both of which were higher than the non-inferiority threshold Δ=-0.06].Conclusion In living kidney transplantation,renal perfusion with norepinephrine is not inferior to that with dopamine,and the recovery of renal function within 7 days after operation is not different from that with do-pamine.
万方数据
维普
