切换至 "中华医学电子期刊资源库"

中华移植杂志(电子版) ›› 2019, Vol. 13 ›› Issue (03) : 224 -227. doi: 10.3877/cma.j.issn.1674-3903.2019.03.013

所属专题: 文献

论著

加速康复外科在肾移植术后静脉补液中的应用
徐小松1, 唐茂芝1, 李羿1, 赵洪雯1, 杨琴1, 唐晓鹏1, 张克勤1, 周强1, 刘宏1,()   
  1. 1. 400038 重庆,陆军军医大学第一附属医院肾科
  • 收稿日期:2019-01-02 出版日期:2019-08-25
  • 通信作者: 刘宏
  • 基金资助:
    国家自然科学基金(81273258)

Application of enhanced recovery after surgery in intravenous fluid infusion after renal transplantation

Xiaosong Xu1, Maozhi Tang1, Yi Li1, Hongwen Zhao1, qin Yang1, Xiaopeng Tang1, Keqin Zhang1, Qiang Zhou1, Hong Liu1,()   

  1. 1. Department of Nephrology, the First Hospital Affiliated to Army Medical University, Chongqing 400038, China
  • Received:2019-01-02 Published:2019-08-25
  • Corresponding author: Hong Liu
  • About author:
    Corresponding author: Liu Hong, Email:
引用本文:

徐小松, 唐茂芝, 李羿, 赵洪雯, 杨琴, 唐晓鹏, 张克勤, 周强, 刘宏. 加速康复外科在肾移植术后静脉补液中的应用[J/OL]. 中华移植杂志(电子版), 2019, 13(03): 224-227.

Xiaosong Xu, Maozhi Tang, Yi Li, Hongwen Zhao, qin Yang, Xiaopeng Tang, Keqin Zhang, Qiang Zhou, Hong Liu. Application of enhanced recovery after surgery in intravenous fluid infusion after renal transplantation[J/OL]. Chinese Journal of Transplantation(Electronic Edition), 2019, 13(03): 224-227.

目的

探讨加速康复外科(ERAS)在肾移植术后静脉补液中的应用。

方法

回顾性分析陆军军医大学第一附属医院124例肾移植受者临床资料。根据肾移植术后多尿期每24小时静脉补液量分为3组,A组每24小时静脉补液量2 500~<4 000 mL,术后6 h进食流质;B组每24小时补液量4 000~6 000 mL,肛门排气后进食;C组每24小时补液量>6 000 mL,肛门排气后进食。采用单因素方差分析比较3组受者术后1周中心静脉压(CVP)、心率、血压、尿量和血糖以及平均特护时间、平均住院日和术后1个月血清肌酐。采用χ2检验比较3组受者性别、供肾类型以及术后高血糖、伤口延迟愈合和移植肾功能延迟恢复(DGF)发生率。P<0.05为差异有统计学意义。

结果

A、B和C组受者术后1个月血清肌酐分别为(110±23)、(114±22)和(118±22)μmol/L,差异无统计学意义(F=1.19,P>0.05)。A组受者术后1周CVP、收缩压、尿量和血糖均低于B、C组(P均<0.05),平均特护时间和平均住院日均短于B、C组(P均<0.05)。3组受者术后高血糖和DGF发生率差异均无统计学意义(χ2=4.581和0.404,P均>0.05),A组受者伤口愈合延迟发生率低于C组(χ2=7.303,P<0.017)。仅C组1例受者因心力衰竭和肺水肿死亡。

结论

ERAS适用于肾移植受者术后静脉补液策略,鼓励受者尽早饮水进食,在保证血压正常或偏高的情况下,适当减少静脉补液量,有利于减少并发症,促进受者恢复。

Objective

To explore the application of enhanced recovery after surgery (ERAS) in intravenous fluid infusion after renal transplantation.

Methods

The clinical data of 124 renal transplantation recipients in the First Hospital Affiliated to Army Medical University were retrospectively analyzed. The recipients were divided into group A, group B and group C. The 24-hour intravenous fluid infusion was 2 500 -<4 000 mL in group A, and the recipients took fluids 6 hours after the surgery. The 24-hour intravenous fluid infusion was 4 000-6 000 mL in group B, and the recipients took fluids after anus exhaust. The 24-hour intravenous fluid infusion was more than 6 000 mL in group C, and the recipients took fluids after anus exhaust. The indexes between the 3 groups including central venous pressure (CVP), heart rate, blood pressure, urine volume and blood glucose 1 week after renal transplantation, and serum creatinine 1 month after renal transplantation, and the mean time in intensive care unit and average length of stay were compared with one-way analysis of variance. The gender of recipients, type of donor kidney, and the incidence of hyperglycemia, delayed wound healing and delayed graft function (DGF) after transplantation between the 3 groups were compared with chi-square test.

Results

The serum creatinine of the recipients between the 3 groups 1 month after transplantation were (110±23), (114±22) and (118±22) μmol/L respectively, which had no statistic difference (F=1.19, P>0.05). The CVP, systolic pressure, urine volume and blood glucose of the recipients in group A 1 week after transplantation were all lower than group B and C (P all<0.05). The mean time in intensive care unit and average length of stay of recipients in group A were shorter than group B and C (P all<0.05). No statistic difference were found for the incidence of hyperglycaemia and DGF between the 3 groups (χ2=4.581 and 0.404, P all >0.05). The incidence of delayed wound healing of group A was lower than group C (χ2=7.303, P<0.017). Only 1 recipient in group C died of heart failure and pneumonedema.

Conclusions

ERAS was applied to recipients after renal transplantation. Taking fluids as soon as possible and reducing the amount of infusion in the situation of normotension or slight hypertension were conducive to reduce postoperative complications, and is beneficial to postoperative recovery.

表1 肾移植术后多尿期每24小时静脉补液量不同的3组受者一般资料
表2 肾移植术后多尿期每24小时静脉补液量不同的3组受者术后1周恢复情况(±s)
表3 肾移植术后多尿期每24小时静脉补液量不同的3组受者术后并发症发生情况[例(%)]
1
Wilmore DW, Kehlet H. Management of patients in fast track surgery[J]. BMJ, 2001,322(7284): 473-476.
2
Kehlet H, Wilmore DW. Multimodal strategies to improve surgical outcome[J]. Am J Surg, 2002,183(6): 630-641.
3
Kehlet H, Dahl JB. Anaesthesia, surgery, and challenges in postoperative recovery[J]. Lancet, 2003,362(9399): 1921-1928.
4
Echeverri J, Goldaracena N, Singh AK, et al. Avoiding ICU admission by using a fast-track protocol is safe in selected adult-to-adult live donor liver transplant recipients[J]. Transplant Direct, 2017,3(10): e213.
5
Biancofiore G, Tomescu DR, Mandell MS. Rapid recovery of liver transplantation recipients by implementation of fast-track care steps: what is holding us back?[J]. Semin Cardiothorac Vasc Anesth, 2018,22(2): 191-196.
6
Callaghan CJ, Mumford L, Pankhurst L, et al. Early outcomes of the new UK Deceased Donor Kidney Fast-Track Offering Scheme[J]. Transplantation, 2017,101(12): 2888-2897.
7
王华. 亲体肾移植护理中快速康复的价值探析[J]. 临床医学研究与实践,2017,2(34): 138-139.
8
金宗兰,丁萍,廖贵益,等. 多学科团队合作模式对亲属活体供肾移植患者康复的影响[J]. 实用医学杂志,2016,32(8): 1344-1347.
9
石富华,黄贵华. 快速康复护理实施在亲体肾移植护理中的效果分析[J/CD]. 中西医结合心血管病杂志(电子版), 2018,6(2): 10-11.
10
雷文华,彭文翰,吕军好,等. 加速康复外科在肾移植围手术期管理中的应用[J/CD]. 中华移植杂志:电子版,2018,12(3): 116-120.
11
Kruszyna T, Niekowal B, Kras'nicka M, et al. Enhanced recovery after kidney transplantation surgery[J]. Transplant Proc, 2016,48(5): 1461-1465.
12
虞文魁,李宁. 加速康复外科理念指导下的围手术期液体治疗[J]. 中国实用外科杂志,2017,37(4): 342-344.
13
罗仕源,徐小松,张克勤. 肾移植术后多尿期大量补液对早期肾功能恢复的影响[J]. 重庆医学,2018,47(26): 3379-3382.
[1] 中华医学会器官移植学分会. 遗体捐献肾脏获取手术技术操作指南[J/OL]. 中华移植杂志(电子版), 2024, 18(05): 257-265.
[2] 邹永康, 石雍, 徐贤刚, 张帅民, 刘衍, 杨生鹏, 叶啟发, 陈根, 张毅. 肾移植术后手术切口米根霉感染伴菌血症一例并文献复习[J/OL]. 中华移植杂志(电子版), 2024, 18(05): 289-292.
[3] 吕玥彤, 靳梦圆, 周大为, 叶啟发. 机器人辅助下肾移植的临床进展与争议[J/OL]. 中华移植杂志(电子版), 2024, 18(04): 242-246.
[4] 尚丽红, 王志华, 张文艳, 朱琳茹, 周华. 内皮粘蛋白抗体与肾移植术后抗体介导排斥反应和移植肾预后的研究[J/OL]. 中华移植杂志(电子版), 2024, 18(03): 165-170.
[5] 吕军好, 林锦雯, 张心怡, 陈江华. 细胞外囊泡在肾移植诊断和治疗中的研究进展[J/OL]. 中华移植杂志(电子版), 2024, 18(03): 186-192.
[6] 陆婷, 陈浩, 王雪静, 谭若芸, 彭宇竹. 肾移植术后一年发生代谢综合征的危险因素分析[J/OL]. 中华移植杂志(电子版), 2024, 18(02): 98-103.
[7] 郭明星, 徐烨, 徐菀佚, 赵莹, 刘冉佳, 潘晨, 崔向丽. 2017—2022年中国105家医院肾移植术后门诊受者免疫抑制剂用药分析[J/OL]. 中华移植杂志(电子版), 2024, 18(02): 104-109.
[8] 许桂祥, 吴海华, 赵鸿志, 徐丽, 胡晓萍, 周世龙, 武永明, 彭新刚. 后鞘前入路腹腔镜视野下腹股沟区脂肪归属的解剖要点及临床意义[J/OL]. 中华疝和腹壁外科杂志(电子版), 2024, 18(03): 277-281.
[9] 成紫琳, 戴明, 李建华, 马靓. 加速康复外科理念在儿童腹股沟疝围手术期的应用[J/OL]. 中华疝和腹壁外科杂志(电子版), 2024, 18(03): 331-335.
[10] 王招荐, 曹桢, 郭小双, 靳小雷, 刘子文. 加速康复外科理念应用于腹壁重建手术的系统评价及Meta分析[J/OL]. 中华疝和腹壁外科杂志(电子版), 2024, 18(03): 343-350.
[11] 贾雪敏, 刘海元. 加速康复外科在卵巢囊肿患者围术期的应用[J/OL]. 中华腔镜外科杂志(电子版), 2024, 17(01): 36-38.
[12] 冯嘉楠, 蔡磊, 何国林, 付顺军, 张成, 冯周彬, 温耀鸿, 谭洪坤, 潘明新. 腹腔镜胆总管切开探查取石一期缝合的安全性与疗效:附128例分析[J/OL]. 中华肝脏外科手术学电子杂志, 2024, 13(04): 543-550.
[13] 朱志, 张鑫炜, 谭文斐, 高梓茗, 赵睿涵, 杨野, 王世洋, 智冬梅, 赵鑫, 尹长欣, 高畅远, 王锡山, 王振宁, 李凯, 周海涛. 直肠癌经自然腔道取标本手术在日间手术中的应用[J/OL]. 中华结直肠疾病电子杂志, 2024, 13(04): 329-334.
[14] 张秋玥, 程羽, 牛雨田, 唐茂芝, 张克勤, 张懿, 郭亚楠, 涂增. 肾移植与人体微生态的相关性研究进展[J/OL]. 中华临床医师杂志(电子版), 2024, 18(02): 207-213.
[15] 马建惠, 韩琦, 李韶玲. 加速康复外科护理路径+量化评估对腹腔镜胆囊切除术高龄患者手术室护理满意度的影响[J/OL]. 中华胃食管反流病电子杂志, 2024, 11(01): 53-56.
阅读次数
全文


摘要