ABSTRACT
Objective:
To evaluate the effect of
sodium bicarbonate Ringer′s
solution on
acute kidney injury(AKI) following laparoscopic
hepatectomy in
elderly patients.
Methods:
A total of 362 American Society of
Anesthesiologists Physical Status
classification Ⅱ or Ⅲ
elderly patients,
aged 65-79 yr, with
body mass index of 18-28 kg/m 2, scheduled for elective laparoscopic
hepatectomy, were divided into 2 groups( n=181 each) using a random number table
method:
bicarbonate Ringer′s
solution group(BR group) and lactated Ringer′s
solution group(LR group).
Bicarbonate Ringer′s
solution and lactated Ringer′s
solution were intravenously infused in BR group and LR group, respectively. All operations were performed under
general anesthesia combined with abdominal
fascia block, and the
methods of controlled low
central venous pressure and intermittent hepatic inflow occlusion were applied to reduce intraoperative
bleeding.
Radial artery blood samples were collected for
blood gas analysis at 5 min before
anesthesia induction(T 0), 20 min after occluding
liver hilus(T 1), 10 min after
hepatectomy and
hemostasis(T 2), at the end of
surgery(T 3) and at postanesthesia care unit discharge(T 4), and
lactate value(Lac) was recorded.
Blood samples from cubital
vein were collected on admission to
hospital(T A) and at 24(T 24) and 48 h after operation(T 48) for
determination of
serum creatinine(Cr) concentrations. Doppler-based renal resistive index(RRI) was measured at T A, T 4, T 24 and T 48. The
incidence of AKI was calculated within 48 h after operation according to the
Kidney Disease Improving Global Outcomes criteria in 2012 for Cr concentration. Adverse reactions(such as
nausea and
vomiting) and
complications(such as incision
infection) within 48 h after operation were recorded.
Results:
Compared with the baseline at T 0, Lac concentrations were significantly increased at T 1-4 in both groups( P<0.01). Cr concentrations were significantly increased at T 24 and T 48, and RRI was increased at T 4, T 24 and T 48 than at T A in both groups( P<0.01). Compared with group LR, the
incidence of AKI within 48 h after operation, Lac concentrations at T 3, 4, Cr concentrations at T 24 and T 48, and RRI at T 4, T 24 and T 48 were significantly decreased in group BR( P<0.05 or 0.01). There was no significant difference in the
incidence of
nausea,
vomiting, incision
infection,
delirium,
bile leakage and pulmonary
infection within 48 h after operation among the two groups( P>0.05).
Conclusions:
Sodium bicarbonate Ringer′s
solution can decrease the development of AKI following laparoscopic
hepatectomy in
elderly patients.