远隔肢体缺血预处理对肝移植病人肾脏的保护作用OA

Objective To investigate the protective effect of remote ischemic preconditioning(RIPC)on the kidneys of pa-tients undergoing liver transplantation.Methods A total of 72 patients who underwent allogeneicliver transplantation were en-rolled and randomly divided into control group and RIPC group,with 36 patientsin each group.A pneumatic tourniquet was place-don the left lower limb for the patients in both groups;inflation or deflation was not performed for the patients in the control group,and for those in the observation group,RIPC was performed at 10 minutes after the surgery started.Venous blood samples were collected immediately before surgery(T1),after portal vein occlusion for 30 minutes(T2),after portal vein opening for 2 h(T3),and at 24 h(T4),48 h(T5),72 h(T6),and 96 h(T7)after surgery to measure the levels of serum creatinine(Scr),blood urea nitrogen(BUN),and cystatin C(Cys C),and estimated glomerular filtration rate(eGFR)was calculated.The two groups were compared in terms of urine volume inthepre-anhepatic stage,the anhepatic phase,and the neohepaticphase and during surgery,as well as 24-hour urine volume on days 1,2,3,and 4 after surgery.Results Compared with the control group,the RIPC group had a significantly lower level of Scr at T4 and T5(F=4.061,5.725,P＜0.05),a significantly lower serum level of BUN at T5 and T6(F=13.446,9.989,P＜0.05),and a significantly lower serum level of Cys C at T5(F=4.252,P＜0.05).There was no significant different in the serum level of eGFR between the two groups at each time point(P＞0.05).Compared with the control group,the RIPC group had a significantly lower total urine volume during surgery(U=-2.236,P＜0.05)and a significantly higher urine volume on day 3 after surgery(U=-2.326,P＜0.05),and there was no significant difference between the two groups at the other time points(P＞0.05).There were no significant differences between the two groups in postoperative acute kidney injury,adverse events of the lower limbs,duration of mechanical ventilation,duration of ICU stay,and length of hos-pital stay(P＞0.05).Conclusion RIPC reduces the degree of postoperative renal impairment in liver transplant recipients and protects their kidneys.