Karaciğer nakil alıcılarında idrar parsiyel oksijen basıncı ölçümlerinin postoperatif dönemde akut böbrek hasarı (ABH) gelişimini öngörme üzerine etkisi
Küçük Resim Yok
Tarih
2024
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İnönü Üniversitesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Amaç: Çalışmamızda karaciğer nakli ameliyatlarında postoperatif dönemde sık karşılaşılan akut böbrek hasarının (ABH) erken tanınmasında idrar parsiyel oksijen basınç düzeyi ölçümlerinin etkinliğini araştırmayı amaçladık. Materyal Metot: Prospektif olarak yapılan çalışmamız, tek merkezli bir çalışma olarak planlanmış olup 17 Ağustos 2023 ile 25 Mart 2024 tarihleri arasında İnönü Üniversitesi Tıp Fakültesi Turgut Özal Tıp Merkezi Karaciğer Nakil Enstitüsünde yapıldı. Çalışmaya fulminan hepatik yetmezlik nedeniyle acil nakil olan, hepatik ensefalopati gelişen, cerrahi öncesi hepato-renal veya hepato-pulmoner sendrom gelişmiş olan, kadaverik nakil yapılan ve 18-65 yaş arası olmayan hastalar dışlandıktan sonra gerçekleştirilen toplam 139 karaciğer nakil hastasından 99 hasta dahil edildi. Hastalardan cerrahi giriş (T1) cerrahi bitimi (T4) ve post-op 24.saatte (T5) idrar örneği alınıp kan gazı cihazında çalışıldı ve parsiyel oksijen düzeyleri kayıt altına alındı. Bununla beraber post-op 24.saatte plazma NGAL düzeyleri ölçümü yapıldı. Hastalar akut böbrek hasarı (ABH) gelişen ve gelişmeyen olarak iki gruba ayrıldı ve gruplandırılırken kidney disease improving global outcomes (KDİGO) tanı sınıflandırılması kullanıldı. Bulgular: Çalışmaya alınan 99 hastanın idrar parsiyel oksijen basıncı (PuO2) değerleri gruplar arası karşılaştırıldı sadece postoperatif 24.saat (T5) zaman noktasında Grup ABH' ta daha yüksek olmak üzere istatistiksel anlamlılık gözlendi. Gruplar arası karşılaştırmada ameliyat bitim (T4) zamanında FiO2' de ve operasyon bitiminde laktatta gruplar arası anlamlı farklılık tespit edildi. Farklılık ABH grubunda daha yüksek bulundu. NGAL değerleri incelendiğinde tüm hastaların ortalama değeri 124.63±157.5 pg/mL olduğu, kontrol grubunda 64.981(1-608.5), ABH grubunda 68.39(1-671) olduğu ve gruplar arası karşılaştırmada anlamlı farklılık olmadığı (p>0.05) görüldü. Toplam 37 hastada ABH gelişmiş ancak kalıcı renal yetmezlik gelişen hasta olmamıştır. ABH gelişen grubun hemodinamik olarak anstabil olduğu, daha asidotik olduğu ve vazopressör desteğe daha çok ihtiyacı olduğu görüldü. Sonuç: Sonuç olarak çalışmamızda ABH' nı öngörmede noninvaziv aralıklı PuO2 ölçüm değerlerinin ABH' ı öngörmede yetersiz olduğunu saptadık ancak konuyla ilgili daha fazla sayıda prospektif çalışmanın yapılması gerektiği kanaatindeyiz. Anahtar Kelimeler: Karaciğer nakli, postoperatif akut böbrek hasarı (ABH), plazma NGAL, idrar parsiyel oksijen basıncı (PuO2), KDIGO
Objective: In our study, we aimed to investigate the efficacy of urine partial oxygen pressure level measurements in the early recognition of acute kidney injury (AKI), which is frequently encountered in the postoperative period in liver transplant surgery. Materials and Methods: Our prospective, single-center study was conducted at the Inonu University Faculty of Medicine, Turgut Ozal Medical Center Liver Transplant Institute, between August 17, 2023, and March 25, 2024. After excluding patients with fulminant hepatic failure requiring emergency transplantation, hepatic encephalopathy, preoperative hepatorenal or hepatopulmonary syndromes, cadaveric transplants, and those outside the age range of 18–65 years, 99 patients out of a total of 139 liver transplant recipients were included. Urine samples were collected at three time points: surgical initiation (T1), surgical completion (T4), and 24 hours postoperatively (T5). These samples were analyzed using a blood gas analyzer to measure partial oxygen pressure levels. Plasma NGAL levels were also measured 24 hours postoperatively. Patients were categorized into two groups based on the presence or absence of acute kidney injury (AKI), as defined by kidney disease improving global outcomes (KDIGO) diagnostic criteria. Results: Urine partial oxygen pressure (PuO2) values of 99 patients included in the study were compared between the groups and statistical significance was observed only at the postoperative 24th hour (T5) time point, which was higher in Group AKI. There was a significant difference between the groups in FiO2 at the end of the operation (T4) and lactate at the end of the operation. The difference was found to be higher in the ABH group. When NGAL values were analyzed, the mean value of all patients was 124.63±157.5 pg/mL, 64.981(1-608.5) in the control group and 68.39(1-671) in the AKI group and there was no significant difference between the groups (p>0.05). A total of 37 patients developed AKI but no patient developed permanent renal failure. It was observed that the group with AKI was hemodynamically anstable, more acidotic and needed vasopressor support more. Conclusion: In conclusion, we found that noninvasive intermittent PuO2 measurements were inadequate in predicting ABH in our study, but we believe that more prospective studies should be conducted on the subject. Keywords: Liver transplantation, postoperative acute kidney injury (AKI), plasma neutrophil gelatinase-associated lipocalin (NGAL), urinary partial oxygen pressure (PuO?) , kidney disease improving global outcomes (KDIGO)
Objective: In our study, we aimed to investigate the efficacy of urine partial oxygen pressure level measurements in the early recognition of acute kidney injury (AKI), which is frequently encountered in the postoperative period in liver transplant surgery. Materials and Methods: Our prospective, single-center study was conducted at the Inonu University Faculty of Medicine, Turgut Ozal Medical Center Liver Transplant Institute, between August 17, 2023, and March 25, 2024. After excluding patients with fulminant hepatic failure requiring emergency transplantation, hepatic encephalopathy, preoperative hepatorenal or hepatopulmonary syndromes, cadaveric transplants, and those outside the age range of 18–65 years, 99 patients out of a total of 139 liver transplant recipients were included. Urine samples were collected at three time points: surgical initiation (T1), surgical completion (T4), and 24 hours postoperatively (T5). These samples were analyzed using a blood gas analyzer to measure partial oxygen pressure levels. Plasma NGAL levels were also measured 24 hours postoperatively. Patients were categorized into two groups based on the presence or absence of acute kidney injury (AKI), as defined by kidney disease improving global outcomes (KDIGO) diagnostic criteria. Results: Urine partial oxygen pressure (PuO2) values of 99 patients included in the study were compared between the groups and statistical significance was observed only at the postoperative 24th hour (T5) time point, which was higher in Group AKI. There was a significant difference between the groups in FiO2 at the end of the operation (T4) and lactate at the end of the operation. The difference was found to be higher in the ABH group. When NGAL values were analyzed, the mean value of all patients was 124.63±157.5 pg/mL, 64.981(1-608.5) in the control group and 68.39(1-671) in the AKI group and there was no significant difference between the groups (p>0.05). A total of 37 patients developed AKI but no patient developed permanent renal failure. It was observed that the group with AKI was hemodynamically anstable, more acidotic and needed vasopressor support more. Conclusion: In conclusion, we found that noninvasive intermittent PuO2 measurements were inadequate in predicting ABH in our study, but we believe that more prospective studies should be conducted on the subject. Keywords: Liver transplantation, postoperative acute kidney injury (AKI), plasma neutrophil gelatinase-associated lipocalin (NGAL), urinary partial oxygen pressure (PuO?) , kidney disease improving global outcomes (KDIGO)
Açıklama
Anahtar Kelimeler
Anestezi ve Reanimasyon, Anesthesiology and Reanimation
