中国组织工程研究

中国组织工程研究 ›› 2011, Vol. 15 ›› Issue (5): 792-795.doi: 10.3969/j.issn.1673-8225.2011.05.008

• 肝移植 liver transplantation • 上一篇    下一篇

活体肝移植和尸体肝移植过程中患者肾功能的比较

覃兆军，占乐云，江建立，邓彩英，吕  恩   

  1. 三峡大学人民医院麻醉科，湖北省宜昌市  443000
  • 收稿日期:2010-07-28 修回日期:2010-11-17 出版日期:2011-01-29 发布日期:2011-01-29
  • 作者简介:覃兆军★，男，1976年生，湖北省松滋市人，汉族，2008年徐州医学院毕业，硕士，主治医师，主要从事临床麻醉及重要器官保护方面的研究。 qin1172001@yahoo.com.cn

Comparison of patients’ renal function in the process of living donor liver transplantation and cadaveric liver transplantation

Qin Zhao-jun, Zhan Le-yun, Jiang Jian-li, Deng Cai-ying, Lü En   

  1. Department of Anesthesiology, People’s Hospital, China Three Gorges University, Yichang   443000, Hubei Province, China
  • Received:2010-07-28 Revised:2010-11-17 Online:2011-01-29 Published:2011-01-29
  • About author:Qin Zhao-jun★, Master, Attending physician, Department of Anesthesiology, People’s Hospital, China Three Gorges University, Yichang 443000, Hubei Province, China qin1172001@yahoo.com.cn

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摘要：

背景：原位肝移植中诸多因素可导致移植后急性肾功能衰竭，但不同移植方式对移植过程中患者肾功能的影响并不清楚。
目的：比较活体部分供肝移植和尸体全肝移植对移植过程中患者肾功能的影响。
方法：纳入拟行活体部分供肝原位肝移植的晚期肝病患者15例设为活体组，采用背驮式原位肝移植；另与同期进行的尸体全肝移植20例患者设为尸体组，采用非转流经典原位肝移植。分别于切皮前即刻、切皮后1 h、无肝期30 min、新肝期1 h及新肝期4 h测定血流动力学和肾功能指标。
结果与结论：两组患者各时间点平均动脉压、心率比较差异无显著性意义(P > 0.05)，活体组无肝期30 min时心输出量、心指数高于尸体组，而体循环血管阻力、体循环血管阻力指数低于尸体组(P < 0.05)。两组移植过程中各时点血清胱抑素C、β2-微球蛋白、肌酐及肌酐清除率均在正常范围内，总尿量及呋噻米用量比较差异无显著性意义(P > 0.05)，但活体组无肝期分钟尿量明显多于尸体组(P  < 0.05)。提示活体部分供肝移植和尸体全肝移植对移植过程中患者肾功能均未产生不利影响。

关键词: 肾功能, 肝移植, 活体供体, 手术方式, 血流动力学

Abstract:

BACKGROUND: Many factors during orthotopic liver transplantation may lead to acute postoperative renal failure. However, the effect of different surgical procedures on intraoperative renal function is unclear.
OBJECTIVE: To compare the effect of living-related partial liver transplantation and cadaveric liver transplantation on renal function of patients in the process of transplantation.
METHODS: Fifteen end-stage liver disease adult patients with living-related partial liver transplantation are set to living donor group who received piggyback orthotopic liver transplantation; and the other 20 patients with whole cadaveric donor liver transplantation are set to cadaveric donor group at the same time who received classic orthotopic liver transplantation without venovenous bypass. Hemodynamics and renal function parameters were measured immediately before incision, at 1 hour after incision, 30 minutes after clamping portal vein, 1 hour and 4 hours after unclamping portal vein, respectively.
RESULTS AND CONCLUSION: There were no significant differences in both mean arterial pressure (MAP) and heart rate (HR) at each time point between the living donor and cadaveric donor groups (P > 0.05). Compared with cadaveric donor group, both cardiac output (CO) and cardiac index (CI) at 30 minutes after clamping portal vein were significantly higher in living donor group; however, systemic vascular resistance (SVR) and systemic vascular resistance index (SVRI) at 30 minutes anhepatic phase were lower in living donor group than that of the cadaveric donor group (P < 0.05). Serum Cystatin C, β2-microglobulin, creatinine, and creatinine clearance rate (CCR) were all within normal range at all time points in the process of transplantation between the living donor and cadaveric donor groups. There were no significant differences between the total volume of urine and furosemide dosage (P > 0.05). But urine volume per minute during anhepatic phase in living donor group was much more than in cadaveric donor group (P < 0.05). It is indicated that living-related partial liver transplantation and cadaveric donor liver transplantation have no adverse effects on renal function of patients in the process of transplantation.

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