Robot Yardımlı Böbrek Naklinde Bifazlı Sıvı Tedavisi’nin Etkinliği

Amaç: Perioperatif sıvı tedavisi, nakledilen böbreğin işlevini etkileyen faktörlerden biridir. Bu çalışmada, perioperatif hasta stabilizasyonu ve allograft böbrek fonksiyonları üzerine ikili fazlı sıvı tedavisinin etkinliği değerlendirilmiştir. Gereç ve Yöntemler: 2015-2017 yılları arasında gerçekleştirilen 65 canlı vericili robot yardımlı laparoskopik böbrek nakli operasyonu verileri retrospektif olarak analiz edildi (16/04/2018, Protokol no 2018-07-13). Hastalar nakil öncesi diyaliz tedavisi alan grup (Grup Preemptif: GP, n=27) ve nakil öncesi diyaliz tedavisi almayan grup (Grup Non-Preemptif: GNP, n=38) olarak bölündü. Tüm vakalarda ikili fazlı sıvı tedavisi kullanıldı (faz 1=vasküler anastomoz öncesi 1-3 ml/kg/s ve faz 2=vasküler anastomoz sonrası 10-12 ml/kg/s). Hastaların hemodinamik ve biyokimyasal durumu, erken ve geç allograft böbrek fonksiyonları değerlendirildi. Veriler istatistiksel olarak gruplar içinde ve arasında karşılaştırıldı. Bulgular: Tüm hastalarda vasküler anastomoz sonrasında hemodinamik/metabolik stabilite ve diürez elde edildi. Gruplar arasında intravenöz (iv) sıvı toplam miktarında (faz 1’de verilen miktar dışında) fark yoktu, ancak GP’de faz 1’ de verilen sıvı miktarı anlamlı olarak daha azdı (p<0,05). Ameliyat öncesi kan pH ve HCO3 değerleri GP’de düşüktü, Na+ ve Cl- değerleri yüksekti (p<0,05). K+ ve Ca+2 değerlerinde her zaman ve her iki grupta ekstübasyon sonrası pH değerlerinde fark bulunmadı. Ameliyat öncesi kan üre ve kreatinin düzeyleri GP’de anlamlı olarak yüksekti (p<0,05), ancak tüm değerler ameliyat sonrası 1. ve 7. günlerde normale döndü. Uzun süreli takipte, her iki grupta da benzer mortalite ve reddetme oranları görüldü. Sonuç: Sonuçlarımız, canlı vericili robot yardımlı laparoskopik böbrek nakli hastalarında ikili fazlı sıvı tedavisinin hemodinamik/metabolik stabilite ve allograft böbrek fonksiyonlarını elde etmede etkili olduğunu desteklemektedir.

Anahtar Kelimeler:

Anestezi, Sıvı tedavisi, Hemodinamik izleme, Böbrek nakli, Nakil alıcısı, Robot yardımlı cerrahi

Efficacy of Biphasic Fluid Therapy in Robot-Assisted Kidney Transplantation

Objective: Perioperative fluid treatment is among the factors affecting transplant kidney function. In this study, the efficacy of biphasic fluid treatment on per-operative patient stabilization and allograft kidney functions were evaluated. Material and Methods: Data of 65 robotic living releated donor kidney transplantation performed between 2015-2017 were retrospectively analyzed (16/04/2018, Protocol no 2018-07-13). The patients were divided as preemptive (Group Preemptif: GP, n=27) and non-preemptive group (Group Non-Preemptif: GNP, n=38). Biphasic fluid treatment was used in all cases (Phase 1 = before-vascular anastomosis 1-3 ml/kg/h and phase 2 = after-vascular anastomosis 10-12 ml/kg/h, respectively). Hemodynamic and biochemical status of the patients, early and late allograft kidney function were evaluated. Datas were statistically compared within and between the groups. Results: Hemodynamic/metabolic stability and diuresis were achieved after vascular anastomosis in all patients. There was no difference in the total amount of iv fluid given between the groups, except that the amount of fluid given in phase 1 was significantly less in GP (p<0.05). Pre-operative blood pH and HCO3 values were lower, Na+ and Cl- values were higher in GP(p<0.05). No difference was found in K+ and Ca+2 values at all times and pH values after extubation in both groups. Pre-operative blood urea and creatinine levels were significantly higher in GP (p<0.05) but all decreased to normal on postoperative 1 and 7 days. In long-term follow-up, both groups had similar mortality and rejection rates. Conclusion: Our results support that biphasic fluid treatment is effective to achieve hemodynamic/ metabolic stability and allograft kidney functions in robotic living releated kidney transplantation patients.

Keywords:

Anesthesia, Fluid Therapy, Hemodynamic monitoring, Kidney transplantation, Transplant recipient, Robot-assisted surgery,

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