关键词: 代谢性酸中毒, 肾移植, 慢性肾功能衰竭, 碳酸氢钠

Abstract: AIM: To observe whether tight control of metabolic acidosis by infusion of 5% sodium bicarbonate can improve early post-operative renal function in living renal transplant recipients.  METHODS: A total of 120 patients who underwent living donor renal transplant surgery in the First Affiliated Hospital of University of Science and Technology of China from March 2019 to March 2020, ASA Ⅲ-Ⅳ, were randomly divided into observation group and control group using random digits table. In observation group, 5% sodium bicarbonate was infused intra-operatively according to Base Excess (BE) measurements to achieve the normal values of BE (－3 to +3 mmol/L). In control group, infusion of 5% sodium bicarbonate was allowed only in case of severe metabolic acidosis (BE≤－10 mmol/L or pH≤7.25). Minute ventilation was adjusted to keep PaCO2 within the normal range. Hemodynamic parameters of two groups were recorded before anesthesia (T0), 10 minutes after induction of anesthesia (T1), before opening of renal artery (T2), 5 minutes after opening renal artery (T3) and the end of surgery (T4). The amount of bleeding, infusion fluid and operative time were recorded. Creatinine,urea nitrogen, urine outputs were recorded on days 1, 2, 3, 7 ,30 after surgery. RESULTS: Compared with the control group, the amount of 5% sodium bicarbonate was significantly increased, the phenylephrine was decreased in the observation group (P<0.05), there was no indication of 5% sodium bicarbonate infusion in control group; the pH and BE in observation group were significantly higher than that in control group at the end of surgery (P<0.05). The MAP and CVP of both groups at T3 were lower than before anesthesia (P<0.05).The creatinine and urea nitrogen of observation group was lower than control group on days 1, 2, 3, 7 after surgery (P<0.05). The urine volume of observation group was higher than control group on days 1, 2, 3 after surgery(P<0.05). CONCLUSION: Intraoperative tight control of metabolic acidosis by infusion of 5% sodium bicarbonate in living renal transplant recipients may improve early post-operative renal function.

Key words: metabolic acidosis, renal transplantation, chronic renal failure, sodium bicarbonate