肝移植术中呼气末二氧化碳下降与术后发生急性肾损伤的关系
The relationship between the decrease of end expiratory carbon dioxide during liver transplantation and the occurrence of acute kidney injury after surgery
陈咏怡 1徐亚奇 1杨世伟 2韩冬冬 2段军3
作者信息
- 1. 中日友好医院(中日友好临床医学研究所)/北京协和医学院/中国医学科学院,北京 100730;中日友好医院重症医学科,北京 100029
- 2. 中日友好医院肝移植中心,北京 100029
- 3. 中日友好医院重症医学科,北京 100029
- 折叠
摘要
目的 探讨肝移植术中呼气末二氧化碳(etCO2)是否与肝移植术后发生急性肾损伤(AKI)相关.方法 回顾性收集83例行经典式同种异体原位肝移植手术患者的临床资料,根据术后48 h内血清肌酐水平变化将患者分为AKI组和非AKI组,并分析组间基础资料、术中etCO2下降率[ΔetCO2(％)]及术后肌酐值等差异.结果 83例肝移植患者术后48 h内AKI发生率为56.6％(47/83).AKI组男性患者占比更多(P=0.003),AKI组患者的无肝期ΔetCO2(％)高于非AKI患者[(0.26±0.08)％vs(0.22±0.07)％,P=0.024].两组无肝前期、夹闭 IVC 时、新肝期 ΔetCO2(％)差异均无统计学意义(均P＞0.05).AKI组术后第7天肌酐值显著高于非AKI组[68.7(55.4,92.6)μmol/Lvs 52.7(44.1,69.3)μmol/L,P＜0.001],3 个月随访时 AKI 组 43 例(91.5％)患者的肌酐恢复正常.结论 肝移植术中无肝期ΔetCO2(％)下降幅度一定程度上反映了术中循环的剧烈波动,可能与术后48 h内发生AKI有关.
Abstract
Objective To investigate whether end-tidal carbon dioxide(etCO2)is associated with acute kidney injury(AKI)after liver transplantation.Methods Clinical data of 83 patients undergoing classic allogeneic liver transplantation were retrospectively collected.Patients were divided into AKI group and non AKI group based on changes in serum creatinine levels within 48 hours after surgery,and differences in baseline data,intraoperative etCO2 decrease rate[ΔetCO2(％)],and postoperative creatinine values were analyzed between the groups.Results The incidence of AKI within 48 hours after liver transplantation in 83 patients was 56.6％(47/83).The proportion of male patients in the AKI group was higher(P=0.003),and the ΔetCO2(％)in the anhepatic phase of AKI group patients was higher than that of non AKI patients[(0.26±0.08)％vs(0.22±0.07)％,P=0.024].There was no statistically significant difference in ΔetCO2(％)between the two groups during pre liver,inferior vena cava(IVC)occlusion,and new liver phase(all P＞0.05).On the 7th day after surgery,the creatinine value in the AKI group was significantly higher than that in the non AKI group[68.7(55.4,92.6)]pmol/L vs 52.7(44.1,69.3)μmol/L,P＜0.001],at a 3-month follow-up,creatinine levels in 43 patients(91.5％)in the AKI group returned to normal.Conclusions The decrease in ΔetCO2(％)during the anhepatic phase of liver transplantation reflects to some extent the severe fluctuations in circulation during the operation,which may be related to the occurrence of AKI within 48 hours after surgery.
关键词
肝移植/呼气末二氧化碳/急性肾损伤Key words
Liver transplantation/End-tidal carbon dioxide/Acute kidney injury引用本文复制引用
基金项目
中央高水平医院临床科研业务费项目(2022-NHLHCRF-LX-03)
出版年
2024
NETL
NSTL
万方数据