Effect Of Nitroglycerin On Renal Function In Renal Transplant Recipients During Perioperative Period

BACKGROUND:Renal transplantation is one of the effective methods for the treatment of end-stage renal disease.After years of continuous development,renal transplantation technology has gradually matured.However,ischemia-reperfusion injury is an unavoidable process of renal transplantation and one of the important causes of postoperative acute renal injury.Acute renal injury directly affects the short-term prognosis and long-term survival of renal transplant recipients.Therefore,reducing ischemia-reperfusion injury is of great significance for improving the prognosis of renal transplant recipients.Nitroglycerin produces nitric oxide through nitric oxide synthase.Nitric oxide can inhibit neutrophil activation and platelet aggregation,thereby reducing microcirculation permeability,reducing vascular inflammation and tissue edema,thereby improving microcirculation blood flow and the perfusion of ischemic tissue;nitric oxide can also inhibit cellular necrosis and apoptosis,reduce the effects of ischemia-reperfusion injury on cells,promote endothelial-dependent vasodilation,reduce vasoconstriction effects,and improve blood perfusion in ischemic tissues.It has been proved that nitroglycerin can improve microcirculation and reduce ischemia-reperfusion injury.Currently,whether nitroglycerin can reduce ischemia-reperfusion injury of transplanted renal and improve renal function of renal transplant recipients has not been reported,and further research is needed.OBJECTIVE:In this study,the effect of nitroglycerin on renal function and renal regional oxygen saturation of renal transplant recipients was investigated by applying nitroglycerin in renal transplant recipients,aiming to provide references for further improving the prognosis of renal transplant recipients.METHODS:A total of 41 patients undergoing relative renal transplantation with elective general anesthesia in a hospital in Henan Province from April 2021 to January 2022 were selected.American Society of Anesthesiologists grade Ⅱ-Ⅳ,aged≥18 years,body mass index 18-30 kg/m².According to the random number table,the included patients were randomly divided into two groups:the nitroglycerin group（group N,n=20）and the control group（group C,n=21）.Before induction of anesthesia,ultrasound-guided right transversus abdominis plane block was performed.After induction of anesthesia,combined intravenous and inhalation anesthesia was used during the operation.The bispectral index was maintained at 40-60,and the systolic blood pressure was maintained at more than 130mm Hg.When the transplanted renal artery was opened,group N started to infuse low-dose nitroglycerin（0.2ug/kg/min）intravenously,and group C continued to infuse an equal volume of normal saline,and the infusion was stopped at the end of the operation.The renal regional oxygen saturation was recorded immediately after the operation.Creatinine,creatinine clearance rate,and urea were recorded on the 1st,2nd,and 7th days after the operation;Urine volume during the operation,on the 1st,2nd,and 7th days after the operation were recorded;Lactic acid and PH of arterial blood samples,mean arterial pressure,heart rate before anesthesia（T₀）,30 minutes after renal artery opening（T₁）,and immediately after operation（T₂）were recorded;Intraoperative dopamine dosage,the incidence of delayed functional recovery of the transplanted renal（hemodialysis required within 1 week after operation）,the incidence of postoperative heart failure and pulmonary edema,postoperative hospital stay also were recorded.RESULTS:1.There was no significant difference in general data between the two groups（P>0.05）.2.Compared with group C,the creatinine in group N decreased significantly on the 1st,2nd and 7th days after the operation（P<0.05）.The creatinine clearance rate in group N increased significantly on the1st and 2nd days after the operation（P<0.05）.There was no significant difference in urea between the two groups on the 1st,2nd,and 7th days after the operation（P>0.05）.There was no significant difference in urine volume during the operation,on the 1st,2nd,and 7th days after the operation and renal regional oxygen saturation immediately after the operation between the two groups（P>0.05）.3.There were no significant differences in lactic acid and PH of arterial blood samples,mean arterial pressure and heart rate between the two groups at different time points（P>0.05）.4.There were no significant differences in intraoperative dopamine dosage,postoperative complications and postoperative hospital stay between the two groups（P>0.05）.CONCLUSION:Low-dose nitroglycerin can improve the perioperative renal function of relative renal transplant recipients,and has a protective effect on the transplanted renal.