4.Hemodynamically adjusted infrahepatic inferior venous cava clamping can reduce postoperative deterioration in renal function: a retrospective observational study.
4.Hemodynamically adjusted infrahepatic inferior venous cava clamping can reduce postoperative deterioration in renal function: a retrospective observational study.
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4.血流动力学调整的肝下下静脉结扎可以减少术后肾功能恶化：一项回顾性观察研究。
DOI：
10.1007/s00540-020-02742-6
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发表时间：
2020
期刊：
影响因子：
--
通讯作者：
Saito S.
中科院分区：
文献类型：
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作者：
Ohta J;Kadoi Y;Murooka Y;Matsuoka H;Kanamoto M;Tobe M;Takazawa T;Saito S.
目的肝下腔静脉（IIVC）夹紧术有利于减少肝手术出血量，但会引起明显的全身循环恶化。回顾性评价IIVC夹持程度变化与术后肾功能的关系。方法对2年来59例择期肝手术合并IIVC夹持的患者进行分析。2016年IIVC固定钳入80%（29例），2017年采用血流动力学调整IIVC钳入（30例）。检查术中各项参数，包括总失血量和输血次数。分析了各种血管活性药物的使用情况。术后急性期肾功能评估采用血清肌酐（Cr）和肾小球滤过率（eGFR）估算值。结果两组比较，2016年组麻黄碱、苯肾上腺素的剂量均显著高于2016年组（P= 0.0221、0.0017）。多巴胺的持续剂量在2016年组中显著增加，而去甲肾上腺素的持续剂量则没有。2016组术后即刻和术后第1天（POD） 1血清Cr水平相对于基线（%）显著升高（P= 0.0143, 0.0012）。术后eGFR相对于基线（%）在2016组术后立即和pod 1和2明显更高（P= 0.0042, 0.0003, 0.0382）。结论血流动力学可调IIVC夹紧方式在不影响止血效果的前提下，在保留肾功能方面优于均匀固定夹紧方式。
PurposeInfrahepatic inferior vena cava (IIVC) clamping is beneficial for reducing the amount of bleeding during hepatic surgery, although the associated systemic circulatory deterioration is noticeable. The relationship between changes in the degree of IIVC clamping and postoperative renal function was retrospectively evaluated.MethodsA total of 59 patients who underwent elective hepatic surgery with surgical IIVC clamping in the two years were analyzed. In 2016, constant 80% clamping of the IIVC was performed (29 cases), and in 2017, hemodynamically adjusted IIVC clamping was performed (30 cases). Intraoperative parameters, including total blood loss and number of blood transfusions, were examined. The use of each vasoactive agents was analyzed. Renal function in the acute postoperative phase was evaluated using serum creatinine (Cr) and estimated glomerular filtration rate (eGFR) values.ResultsComparison of the two groups showed that bolus doses of both ephedrine and phenylephrine were significantly higher in the 2016 group (P= 0.0221, 0.0017). Continuous doses of dopamine were significantly higher in the 2016 group, while those of noradrenaline were not. Postoperative serum Cr levels relative to baseline (%) were significantly higher in the 2016 group immediately after surgery and on postoperative day (POD) 1 (P= 0.0143, 0.0012). Postoperative eGFR relative to baseline (%) was significantly higher in the 2016 group immediately postoperatively and on PODs 1 and 2 (P= 0.0042, 0.0003, 0.0382).ConclusionHemodynamically adjustable IIVC clamping might be superior to uniformly fixed clamping in preserving renal function without compromising the desired effect on hemostasis.