Acute Kidney Injury after Hepatic Surgery with Goal Directed Fluid Therapy

DOI Web Site 参考文献24件
  • Sakamoto Miki
    Department of Anesthesiology, St. Marianna University School of Medicine
  • Kobayashi Yuki
    Department of Anesthesiology, St. Marianna University School of Medicine
  • Tanigawa Saori
    Department of Anesthesiology, St. Marianna University School of Medicine
  • Miyakawa Hidetoshi
    Department of Anesthesiology, St. Marianna University School of Medicine
  • Otsubo Takehito
    Department of Surgery, Division of Gastroenterological and General Surgery
  • Tateda Takeshi
    Department of Anesthesiology, St. Marianna University School of Medicine

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Background: Goal-directed therapy (GDT) has been shown to reduce perioperative complications. However, whether the restriction of fluid volume in goal-directed therapy causes acute kidney injury (AKI) remains to be determined. The aim of this study was to determine intraoperative risk factors for AKI after hepatic surgery with goal-directed therapy using restricted fluid volume.<br/>Methods: Anesthesia and medical records of 67 patients who underwent hepatic resection were analyzed. Central venous pressure (CVP) and stroke volume variation (SVV) were monitored continuously by arterial contour analysis using a FloTrack sensorTM (Edwards life sciences LLC, CA, USA) for restrictive fluid management during portal triad clamping (PTC) with inferior vena cava (IVC) clamping. Low CVP (<5 cmH2O) and high SVV (>12%) were achieved by restrictive fluid management during PTC. AKI was assessed using the AKI network definition.<br/>Results: Eight patients developed stage-1 AKI (12%) after hepatic resection, but none of the patients required renal replacement therapy. The durations of anesthesia and PTC were longer in the AKI group than in the non-AKI group (P=0.006 and P=0.004). The IVC was clamped more frequently in the AKI group than in the non-AKI group (P=0.004). The amount of blood loss was larger and the necessity for blood transfusion was higher in the AKI group than in the non-AKI group (P=0.02 and P=0.001).<br/>Conclusion: The duration of PTC with IVC clamping and blood loss affects the incidence of AKI after hepatic surgery using GDT with restrictive fluid volume management. We suggest that unstable hemodynamics during PTC with IVC clamping and blood loss contribute to AKI after hepatic surgery.

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