去甲肾上腺素用于肾移植术中对患者肾功能的影响
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摘要
本研究通过观察去甲肾上腺素用于肾移植术中对患者移植肾功能的影响,旨在探讨肾移植术中辅用去甲肾上腺素的可行性。选择行同种异体肾移植术患者32例,ASAⅢ~Ⅳ级,年龄22~64岁,体重44~88kg,术前血压控制较平稳,无心力衰竭病史。随机分为多巴胺组(D组)和去甲肾上腺素组(N组)各16例,麻醉后肾血流开放前血压下降低于术前基础血压时D组静脉输注多巴胺1~10μg·kg~(-1)·min~(-1),N组静脉输注去甲肾上腺素0.01~0.4μg·kg-1·min-1,血压维持在术前基础血压或略高水平。两组分别于麻醉前(T0),肾动静脉开放前即刻(T1),肾动静脉开放后10min(T2),手术结束即刻(T3)记录患者收缩压(SBP)、舒张压(DBP)、平均动脉压(MAP)、中心静脉压(CVP)、心率(HR)、脉搏血氧饱和度(SPO2)各参数的变化;分别于手术结束即刻(T3),术后12小时(T4)采样测定患者外周血清半胱氨酸蛋白酶抑制剂C(Cystatin C)、β2-微球蛋白(β2-MG)和尿α1-微球蛋白(α1-MG)、β2-微球蛋白(β2-MG)浓度,并记录术毕时与术后12小时的尿量,以及术后12小时内速尿使用次数。研究结果表明:0.01~0.4μg·kg-1·min-1去甲肾上腺素用于肾移植术中对移植肾功能的恢复无不良影响,它可用于肾移植术中辅助液体扩容提升血压,满足移植肾的灌注。
Objective: To investigate the feasibility of norepinephrine infusion at 0.01~0.4μg·kg-1·min-1during kidney transplantation surgery.
Methods: 32 patients with ASA III~IV, aged 22~64yr, weight 44~88kg and no history of heart failure undergoing allograft renal transplantation were studied. Daily blood pressure was controlled relatively stable. Preoperation dialysis was performed within 36 hours. Combined spinal-epidural anesthesia (CSEA) was elected. Spinal anesthesia was performed at the L2~L3 interspace and hyperbaric 0.5% bupivacaine (10~15mg) was administered into the subrachnoid space. A sensory block to pinprick to T6. Epidural catheter was placed at the T11~T12 and 1% ropivacaine was given intermittently to maintain anesthesia. The patients were randomly allocated into 2 groups (n=16):D group intravenously received 1~10μg·kg-1·min-1 dopamine, while N group intravenously received 0.01~0.4μg·kg-1·min-1 norepinephrine when the blood pressure fell below day-to-day blood pressure before release of the graft vessel clamps. The patients were sedated with midazolam 1mg and continuous infusion of propofol at 2~4mg·kg-1·h-1 during surgery. ECG, IBP, CVP, HR and SPO2 were continuously monitored. SBP, DBP, MAP, CVP, HR and SPO2 were recorded before anesthesia (T0), before release of the graft vessel clamps (T1), 10min after release of the graft vessel clamps (T2) and at the end of surgery (T3). Peripheral vein blood and urine samples were obtained at the end of surgery (T3) and the twelfth postoperation hour (T4) for determination the concentration of serum Cystatin C,β2-microglobubin and urineα1-microglobubin,β2-microglobubin. Urine volume was also recorded at the end of surgery (T3) and the twelfth postoperation hour (T4). Meanwhile , the frequency of furosemide used in twelve hours postoperation was memorized.
Results: The two groups were comparable with respect to age, M/F sex radio, weight, operation time and volume of fluid infused. The hemodynamics was stable in each group and no adverse event was observed in any patient during surgery. At T3, the concentrations of serum Cystatin C,β2-microglobubin and urineα1-microglobubin,β2-microglobubin in both groups were no significance of difference (P>0.05). At T4, the concentrations of serum Cystatin C,β2-microglobubin and urineα1-microglobubin,β2-microglobubin in both groups were no significance of difference (P>0.05). The urine volume at the end of surgery in group N compared with group D increased a lot, but there was no statistic meaning in both groups (P>0.05). The urine volume in postoperation 12h and the frequence of furosemide used in both groups were no statistic meaning (P>0.05).
Conclusion: It’s feasible that norepinephrine infusion intravenously at 0.01~0.4μg·kg-1·min-1 during kidney transplantation surgery. Because norepinephrine is proved equivalent to dopamine in every measured respect and it has no bad influence on graft function recovery.
Objective: To investigate the feasibility of norepinephrine infusion at 0.01~0.4μg·kg-1·min-1during kidney transplantation surgery.
Methods: 32 patients with ASA III~IV, aged 22~64yr, weight 44~88kg and no history of heart failure undergoing allograft renal transplantation were studied. Daily blood pressure was controlled relatively stable. Preoperation dialysis was performed within 36 hours. Combined spinal-epidural anesthesia (CSEA) was elected. Spinal anesthesia was performed at the L2~L3 interspace and hyperbaric 0.5% bupivacaine (10~15mg) was administered into the subrachnoid space. A sensory block to pinprick to T6. Epidural catheter was placed at the T11~T12 and 1% ropivacaine was given intermittently to maintain anesthesia. The patients were randomly allocated into 2 groups (n=16):D group intravenously received 1~10μg·kg-1·min-1 dopamine, while N group intravenously received 0.01~0.4μg·kg-1·min-1 norepinephrine when the blood pressure fell below day-to-day blood pressure before release of the graft vessel clamps. The patients were sedated with midazolam 1mg and continuous infusion of propofol at 2~4mg·kg-1·h-1 during surgery. ECG, IBP, CVP, HR and SPO2 were continuously monitored. SBP, DBP, MAP, CVP, HR and SPO2 were recorded before anesthesia (T0), before release of the graft vessel clamps (T1), 10min after release of the graft vessel clamps (T2) and at the end of surgery (T3). Peripheral vein blood and urine samples were obtained at the end of surgery (T3) and the twelfth postoperation hour (T4) for determination the concentration of serum Cystatin C,β2-microglobubin and urineα1-microglobubin,β2-microglobubin. Urine volume was also recorded at the end of surgery (T3) and the twelfth postoperation hour (T4). Meanwhile , the frequency of furosemide used in twelve hours postoperation was memorized.
Results: The two groups were comparable with respect to age, M/F sex radio, weight, operation time and volume of fluid infused. The hemodynamics was stable in each group and no adverse event was observed in any patient during surgery. At T3, the concentrations of serum Cystatin C,β2-microglobubin and urineα1-microglobubin,β2-microglobubin in both groups were no significance of difference (P>0.05). At T4, the concentrations of serum Cystatin C,β2-microglobubin and urineα1-microglobubin,β2-microglobubin in both groups were no significance of difference (P>0.05). The urine volume at the end of surgery in group N compared with group D increased a lot, but there was no statistic meaning in both groups (P>0.05). The urine volume in postoperation 12h and the frequence of furosemide used in both groups were no statistic meaning (P>0.05).
Conclusion: It’s feasible that norepinephrine infusion intravenously at 0.01~0.4μg·kg-1·min-1 during kidney transplantation surgery. Because norepinephrine is proved equivalent to dopamine in every measured respect and it has no bad influence on graft function recovery.
引文
[1] Ojo AO, Wolfe RA, Held PJ, et al. Delayed graft function: risk factors and implications for renal allograft survival [J]. Transplantation, 1997,63:968- 974.
[2] Kyllonen LE, Salmela KT, Eklund BH, et al. Long-term results of 1047 cadaveric kidney transplantations with special emphasis on initial graft function and rejection [J]. Transpl Int, 2000,13:122-128.
[3] Troppmann C, Gillingham KJ, Benedetti E, et al. Delayed graft function, acute rejection, and outcome after cadaver renal transplantation: The multivariate analysis [J]. Transplantation, 1995,59:962-968.
[4] McLaren AJ, Jassem W, Gray DW, et al. Delayed graft function: risk factors and the relative effects of early function and acute rejection on long-term survival in cadaveric renal transplantation [J]. Clin Transplant, 1999,13:266-272.
[5] Quiroga I, McShane P, Koo Dicken DH,et al. Major effects of delayed graft function and cold ischaemia time on renal allograft survival [J]. Nephrol Dial Transplant, 2006,21:1689-1696.
[6] Perico N, Cattaneo D, Sayegh MH, et al. Delayed graft function in kidney transplantation [J]. Lancet, 2004,364(9447):1814.
[7] Sri G. Yarlagadda, Steven G. Coca, Richard N. Formica, Jr, et al. Association between delayed graft function and allograft and patient survival: a systematic review and meta-analysis [J]. Nephrology Dialysis Transplantation, 2009,24(3):1039-1047.
[8]齐隽,杨继平,闵志廉,等.肾移植术后早期肾功能状态对移植肾长期存活的影响[J].肾脏病与透析肾移植杂志, 2002,11(5):419-423.
[9] Boom H, Paul LC, de Fijter JW. Delayed graft function in renal transplantation [J]. Transplantation Reviews, 2004,18(3):139-152.
[10] Yarlagadda SG, Coca SG, Garg AX, et al. Marked variation in the definition and diagnosis of delayed graft function: a systematic review [J]. Nephrology Dialysis Transplantation, 2008,23(9):2995-3003.
[11]赵豫波,石炳毅,蔡明,等.移植肾功能延迟恢复的危险因素分析[J].解放军医学杂志, 2008,33(1):17-19.
[12]霍文谦,李黔生,靳风烁,等.肾移植后早期移植肾功能异常的危险因素-146例非条件Logistic回归分析[J].中国组织工程研究与临床康复, 2008,12(31):6153-6157.
[13] Koning OH, Ploeg RJ, van Bockel JH, et al. Risk factors for delayed graft function in cadaveric kidney transplantation: a prospective study of renal function and graft survival after preservation with University of Wisconsin solution in multi-organ donors. European Multicenter Study Group [J]. Transplantation, 1997,63(11): 1620-1628.
[14] Grundmann R, Kindler J, Meider G, et al. Dopamine treatment of human cadaver kidney graft recipients: a prospectively randomized trial [J]. Klin Wochenschr, 1982,60(4):193-197.
[15] Dalton RSJ, Webber JN, Cameron C, et al. Physiologic impact of low-dose dopamine on renal function in the early post renal transplant period [J]. Transplantation, 2005,79(11):1561-1567.
[16] A.R.J. Girbes, A.G. Lieverse, A.J. Smit, et al. Lack of specific renal haemodynamic effects of different doses of dopamine after infrarenal aortic surgery [J]. British Journal of Anaesthsia, 1996,77:753-757.
[17] K. Kirchhoff, M. Leuwer, P. Thum, et al. Different effects of dopamine and dopexamine on the isolated perfused rat kidney [J]. British Journal of Anaesthsia, 1999,83(6):898-902.
[18] Cronin RE, de Torrente A, Miller PD, et al. Pathogenic mechanisms in early norepinephrine-induced acute renal failure: functional andhistological correlates of protection [J]. Kidney Int, 1978,14(2):115-125.
[19] Cronin RE, Erickson AM, de Torrente A, et al. Norepinephrine-induced acute renal failure: a reversible ischemic model of acute renal failure [J]. Kidney Int, 1978,14(2):187-190.
[20] Anderson WP, Korner PI, Selig SE. Mechanisms involved in the renal responses to intravenous and renal artery infusions of noradrenaline in conscious dog [J]. Physiol, 1981,321(12):21-30.
[21]王天龙,杨拔贤.去甲肾上腺素在肝移植麻醉中的应用[J].中国普通外科杂志, 2006,21(1):76-78.
[22] Schaer GL, Fink MP, Parrillo JE. Norepinephrine alone versus norepinephrine plus low-dose dopamine: enhanced renal blood flow with combination pressor therapy [J]. Crit Care Med, 1985,13(6):492-496.
[23] Desjars P, Pinaud M, Bugnon D, et al. Norepinephrine therapy has no deleterious renal effects in human septic shock [J]. Crit Care Med, 1989,17(5): 426-429.
[24] Redl-Wenzl EM, Armbruster C, Edelmann G, et al. The effects of norepinephrine on hemodynamics and renal function in severe septic shock states [J]. Intensive Care Med, 1993,19(3):151-154.
[25] Pehl C, Sehepp W. Successful therapy of hepatorenal syndrome with norepinephrine [J]. Z Gasttoenterol, 2000,38(12):945-950.
[26] Alessandria C, Ottobrelli A, Debernardi-Venon W, et al. Noradrenalin vs terlipressin in patients with hepatorenal syndrome: a prospective,randomized, unblinded, pilot study [J]. J Hepatol, 2007,47(4):499-505.
[27] Wong, F. Hepatorenal syndrome: current management [J]. Curr Gastroenterol Rep, 2008,10(1):22-29.
[28] Sharma P, Kumar A, Shrama BC , et al. An open label, pilot, randomized controlled trial of noradrenaline versus terlipressin in the treatment of type I hepatorenal syndrome and predictors of response [J]. Am J Gastroenterol, 2008, 103(7):1689-1697.
[29] Duvoux C, Zanditenas D, Hezode C, et al. Effects of noradrenalin and albumin in patients with type I hepatorenal syndrome: a pilot study [J]. Hepatology, 2002,36(2):374-380.
[30] Zhang Li-ping, Li Min, Yang Lu.Effects of different vasopressors on hemodynamics in patients undergoing orthotopic liver transplantation [J]. Chin Med J (Engl), 2005,118(23):1952-1958.
[31] Dharnidharka VR, Kwon C, Stevens G. Serum cystatin C is superior to serum creatinine as a marker of kidney function: a meta-analysis [J]. Am J Kidney Dis, 2002,40:221-226.
[32] Perlemoine C, Beaurieux MC, Rigalleau D, et a1. Interest of cystatin C in screening diabetic patients for early impairment of renal function [J]. Meta- bolism, 2003,52(1O):1258-1264.
[33] Risch L, Blumberg A, Huber A. Rapid and accurate assessment of glomerular filtration rate in patients with renal transplants using serum Cystatin C [J]. Nephrol Dial Transplant, 1999,14:1991-1996.
[34] Filer G, Priem F, Vollmer I, Gellermann J, Jung K. Diagnostic sensitivity of serum Cystatin C for impaired glomerular filtration rate [J]. Pediatr Nephrol, 1999,13(6):501-506.
[35] Christensson A, Ekberg J, Grubb A, et al. Serum cystatin C is a more sensitive and more accurate marker of glomerular filtration rate than enzymatic measurements of creatinine in renal transplantation [J]. Nephron Physiol, 2003, 94(2):19-27.
[36] Kusano B, Suzudi M, Asano Y,et al. Humanα1-microglobulin and its relashionship to renal function [J]. Nephron, 1985,41:380-382.
[37] Teppo AM, Honkanen E, Ahonen J, et al. Changes of urinaryα1-microglobulin in the assessment of prognosis in renal transplant recipients [J]. Transplantation, 2000,70:1154-1159.
[1]曾力,朱有华,王立明,等.肾移植术后导致肾功能恢复延迟的危险因素分析[J].中华器官移植杂志, 2005,26(11):666-668.
[2]赵豫波,石炳毅,蔡明,等.移植肾功能延迟恢复的危险因素分析[J].解放军医学杂志, 2008,33(1):17-19.
[3]陈杰,曾凡军,金昊,等.肾移植患者发生移植肾功能延迟恢复的危险因素分析及预测[J].中华器官移植杂志, 2006,27(8):456-459.
[4] Pehl C, Sehepp W. Successful therapy of hepatorenal syndrome with norepinephrine [J]. Z Gasttoenterol, 2000,38(12):945-950.
[5] Duvoux C, Zanditenas D, Hezode C, et al. Effects of noradrenalin and albumin in patients with type I hepatorenal syndrome: a pilot study [J]. Hepatology, 2002,36(2):374-380.
[6] Wong, F. Hepatorenal syndrome: current management [J]. Curr Gastroenterol Rep, 2008,10(1):22-29.
[7] Zhang Li-ping, Li Min, Yang Lu.Effects of different vasopressors on hemodynamics in patients undergoing orthotopic liver transplantation [J]. Chin Med J (Engl), 2005,118(23):1952-1958.
[8]王天龙,杨拔贤.去甲肾上腺素在肝移植麻醉中的应用[J].中国普通外科杂志, 2006,21(1):76-78.
[9] Sri G. Yarlagadda, Steven G. Coca, Richard N. Formica, Jr, et al. Association between delayed graft function and allograft and patientsurvival: a systematic review and meta-analysis [J]. Nephrology Dialysis Transplantation, 2009, 24(3):1039-1047.
[10] Grundmann R, Kindler J, Meider G, et al. Dopamine treatment of human cadaver kidney graft recipients: a prospectively randomized trial [J]. Klin Wochenschr, 1982,60(4):193-197.
[11] A.R.J. Girbes, A.G. Lieverse, A.J. Smit, et al. Lack of specific renal haemodynamic effects of different doses of dopamine after infrarenal aortic surgery [J]. British Journal of Anaesthsia, 1996,77:753-757.
[12] Perdue PW, Balser JR, Lipsett PA, et al.‘Renal dose’dopamine in surgical patients: dogma or science [J]? Ann Surg, 1998,227:470-473.
[13] Schafferhans K, Heidbreder E, Grimm D, et al. Norepinephrine- induced acute renal failure: beneficial effects of atrial natriuretic factor [J]. Nephron, 1986,44:240-244.
[14] Anderson WP, Korner PI, Selig SE. Mechanisms involved in the renal responses to intravenous and renal artery infusions of noradrenaline in conscious dogs [J]. J Physiol, 1981,321:21-30.
[15] David Di Giantomasso, Hiroshi Morimatsu, Clive N. May, et al. Increasing Renal Blood Flow: Low-Dose Dopamine or Medium-Dose Norepinephrine [J]. Chest,2004,125(6):2260-2267.
[16] Di Giantomasso D, May CN, Bellomo R. Norepinephrine and vital organ blood flow [J]. Int Care Med, 2002,28(12):1804-1809.
[17] Cronin RE, de Torrente A, Miller PD, et al. Pathogenic mechanisms inearly norepinephrine-induced acute renal failure: functional and histological correlates of protection [J]. Kidney Int, 1978,14(2):115-125.
[18] Cronin RE, Erickson AM, de Torrente A, et al. Norepinephrine- induced acute renal failure: a reversible ischemic model of acute renal failure [J]. Kidney Int, 1978,14(2):187-190.
[19] Dharnidharka VR, Kwon C, Stevens G. Serum cystatin C is superior to serum creatinine as a marker of kidney function: a meta-analysis [J]. Am J Kidney Dis, 2002,40:221-226.
[20] Risch L, Blumberg A, Huber A. Rapid and accurate assessment of glomerular filtration rate in patients with renal transplants using serum Cystatin C [J]. Nephrol Dial Transplant, 1999,14:1991-1996.
[21] Filer G, Priem F, Vollmer I, Gellermann J, Jung K. Diagnostic sensitivity of serum Cystatin C for impaired glomerular filtration rate [J]. Pediatr Nephrol, 1999,13(6):501-506.
[22] Christensson A, Ekberg J, Grubb A, et al. Serum cystatin C is a more sensitive and more accurate marker of glomerular filtration rate than enzymatic measurements of creatinine in renal transplantation [J]. Nephron Physiol, 2003,94(2):19-27.
[2] Kyllonen LE, Salmela KT, Eklund BH, et al. Long-term results of 1047 cadaveric kidney transplantations with special emphasis on initial graft function and rejection [J]. Transpl Int, 2000,13:122-128.
[3] Troppmann C, Gillingham KJ, Benedetti E, et al. Delayed graft function, acute rejection, and outcome after cadaver renal transplantation: The multivariate analysis [J]. Transplantation, 1995,59:962-968.
[4] McLaren AJ, Jassem W, Gray DW, et al. Delayed graft function: risk factors and the relative effects of early function and acute rejection on long-term survival in cadaveric renal transplantation [J]. Clin Transplant, 1999,13:266-272.
[5] Quiroga I, McShane P, Koo Dicken DH,et al. Major effects of delayed graft function and cold ischaemia time on renal allograft survival [J]. Nephrol Dial Transplant, 2006,21:1689-1696.
[6] Perico N, Cattaneo D, Sayegh MH, et al. Delayed graft function in kidney transplantation [J]. Lancet, 2004,364(9447):1814.
[7] Sri G. Yarlagadda, Steven G. Coca, Richard N. Formica, Jr, et al. Association between delayed graft function and allograft and patient survival: a systematic review and meta-analysis [J]. Nephrology Dialysis Transplantation, 2009,24(3):1039-1047.
[8]齐隽,杨继平,闵志廉,等.肾移植术后早期肾功能状态对移植肾长期存活的影响[J].肾脏病与透析肾移植杂志, 2002,11(5):419-423.
[9] Boom H, Paul LC, de Fijter JW. Delayed graft function in renal transplantation [J]. Transplantation Reviews, 2004,18(3):139-152.
[10] Yarlagadda SG, Coca SG, Garg AX, et al. Marked variation in the definition and diagnosis of delayed graft function: a systematic review [J]. Nephrology Dialysis Transplantation, 2008,23(9):2995-3003.
[11]赵豫波,石炳毅,蔡明,等.移植肾功能延迟恢复的危险因素分析[J].解放军医学杂志, 2008,33(1):17-19.
[12]霍文谦,李黔生,靳风烁,等.肾移植后早期移植肾功能异常的危险因素-146例非条件Logistic回归分析[J].中国组织工程研究与临床康复, 2008,12(31):6153-6157.
[13] Koning OH, Ploeg RJ, van Bockel JH, et al. Risk factors for delayed graft function in cadaveric kidney transplantation: a prospective study of renal function and graft survival after preservation with University of Wisconsin solution in multi-organ donors. European Multicenter Study Group [J]. Transplantation, 1997,63(11): 1620-1628.
[14] Grundmann R, Kindler J, Meider G, et al. Dopamine treatment of human cadaver kidney graft recipients: a prospectively randomized trial [J]. Klin Wochenschr, 1982,60(4):193-197.
[15] Dalton RSJ, Webber JN, Cameron C, et al. Physiologic impact of low-dose dopamine on renal function in the early post renal transplant period [J]. Transplantation, 2005,79(11):1561-1567.
[16] A.R.J. Girbes, A.G. Lieverse, A.J. Smit, et al. Lack of specific renal haemodynamic effects of different doses of dopamine after infrarenal aortic surgery [J]. British Journal of Anaesthsia, 1996,77:753-757.
[17] K. Kirchhoff, M. Leuwer, P. Thum, et al. Different effects of dopamine and dopexamine on the isolated perfused rat kidney [J]. British Journal of Anaesthsia, 1999,83(6):898-902.
[18] Cronin RE, de Torrente A, Miller PD, et al. Pathogenic mechanisms in early norepinephrine-induced acute renal failure: functional andhistological correlates of protection [J]. Kidney Int, 1978,14(2):115-125.
[19] Cronin RE, Erickson AM, de Torrente A, et al. Norepinephrine-induced acute renal failure: a reversible ischemic model of acute renal failure [J]. Kidney Int, 1978,14(2):187-190.
[20] Anderson WP, Korner PI, Selig SE. Mechanisms involved in the renal responses to intravenous and renal artery infusions of noradrenaline in conscious dog [J]. Physiol, 1981,321(12):21-30.
[21]王天龙,杨拔贤.去甲肾上腺素在肝移植麻醉中的应用[J].中国普通外科杂志, 2006,21(1):76-78.
[22] Schaer GL, Fink MP, Parrillo JE. Norepinephrine alone versus norepinephrine plus low-dose dopamine: enhanced renal blood flow with combination pressor therapy [J]. Crit Care Med, 1985,13(6):492-496.
[23] Desjars P, Pinaud M, Bugnon D, et al. Norepinephrine therapy has no deleterious renal effects in human septic shock [J]. Crit Care Med, 1989,17(5): 426-429.
[24] Redl-Wenzl EM, Armbruster C, Edelmann G, et al. The effects of norepinephrine on hemodynamics and renal function in severe septic shock states [J]. Intensive Care Med, 1993,19(3):151-154.
[25] Pehl C, Sehepp W. Successful therapy of hepatorenal syndrome with norepinephrine [J]. Z Gasttoenterol, 2000,38(12):945-950.
[26] Alessandria C, Ottobrelli A, Debernardi-Venon W, et al. Noradrenalin vs terlipressin in patients with hepatorenal syndrome: a prospective,randomized, unblinded, pilot study [J]. J Hepatol, 2007,47(4):499-505.
[27] Wong, F. Hepatorenal syndrome: current management [J]. Curr Gastroenterol Rep, 2008,10(1):22-29.
[28] Sharma P, Kumar A, Shrama BC , et al. An open label, pilot, randomized controlled trial of noradrenaline versus terlipressin in the treatment of type I hepatorenal syndrome and predictors of response [J]. Am J Gastroenterol, 2008, 103(7):1689-1697.
[29] Duvoux C, Zanditenas D, Hezode C, et al. Effects of noradrenalin and albumin in patients with type I hepatorenal syndrome: a pilot study [J]. Hepatology, 2002,36(2):374-380.
[30] Zhang Li-ping, Li Min, Yang Lu.Effects of different vasopressors on hemodynamics in patients undergoing orthotopic liver transplantation [J]. Chin Med J (Engl), 2005,118(23):1952-1958.
[31] Dharnidharka VR, Kwon C, Stevens G. Serum cystatin C is superior to serum creatinine as a marker of kidney function: a meta-analysis [J]. Am J Kidney Dis, 2002,40:221-226.
[32] Perlemoine C, Beaurieux MC, Rigalleau D, et a1. Interest of cystatin C in screening diabetic patients for early impairment of renal function [J]. Meta- bolism, 2003,52(1O):1258-1264.
[33] Risch L, Blumberg A, Huber A. Rapid and accurate assessment of glomerular filtration rate in patients with renal transplants using serum Cystatin C [J]. Nephrol Dial Transplant, 1999,14:1991-1996.
[34] Filer G, Priem F, Vollmer I, Gellermann J, Jung K. Diagnostic sensitivity of serum Cystatin C for impaired glomerular filtration rate [J]. Pediatr Nephrol, 1999,13(6):501-506.
[35] Christensson A, Ekberg J, Grubb A, et al. Serum cystatin C is a more sensitive and more accurate marker of glomerular filtration rate than enzymatic measurements of creatinine in renal transplantation [J]. Nephron Physiol, 2003, 94(2):19-27.
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