Улогата на целниот централен венски притисок (ЦВП) врз раната функција на графтот кај бубрежна трансплантација од жив донор

Abstract

Introduction: Early graft function is very important and can be achieved with an adequate intraopeartive perfusion characteristics of the graft and urine output. The goal of this study was to examine the influence of targeting CVP on onset of dieresis and postoperative recovery of the graft in kidney transplantation. Material and methods: After approval of Ethical committee of the Medical Faculty-Skopje we obtained inform consent of 60 patients ASA 2-3 undergoing renal transplantation of living-related person in the Clinic Of Urology –Skopje. A prospective clinical study which was performed in the period of 2 years. They were divided in 2 groups of thirty patients : group A receiving normal saline intraoperativly targeting for CVP 15 mmHg until vascular clamps were off and group B receiving normal saline 10ml/kg/h. The hemodynamic changes were recorded as systolic, diastolic and mean arterial pressure in 4 times. T0 before the induction, T1 after induction, T2 before the clamping the vessels and T3 after unclamping. We also recorded duration of surgery, duration of cold and warm ischemia, amount of normal saline until the unclamping the vessels, lactate at the end of the surgery and total urine output from unclamping the renal vessels to the end of the surgery in both groups. We recorded the administration of plasma expander,dopamine and higher dosage of furosemid than 40mg and we noticed any tissue edema. We noticed postoperative biochemical parmetars in plasma and urine as a guide for postoperative recovery of the graft. Results: There were no statistical significant difference in intraopeartive hemodynamic parameters between both groups in. The onset of diuresis in seconds was insignificantly longer in group B p>0,05 (p=o,31).). The average value of postoperative levels of the lactate showed that in group B the level of the lactate were significantly higher for Z=-5,79 and p<0,001 (p=0,000). We didn’t find any statistical difference in postoperative level of creatinine and fraction-extraction of sodium between both groups. Conclusion: CVP as a guide for volume substitution is still highly recommended in kidney transplantation. The fact that in group B ( the constant infusion group) we had 5(16,7 %) patients in whom we didn’t achieved urine output at the end of the surgery and the level of lactate was higher in group B but in normal clinical range. With this study we can expend the intraopearive recomendation for the CVP range from 8-15 mmHg.