Association Of Intraoperative Upper And Lower Limb Blood Pressure With Postoperative Liver And Renal Function In Patients Treated With Robotic-assisted Radical Prostatectomy

ObjectiveTo explore the changes of intraoperative upper and lower limb blood pressure and the risk factors of postoperative liver and kidney dysfunction in patients undergoing radical laparoscopic radical prostatectomy.MethodsFrom October 2017 to June 2018,110 patients with RARP were consecutively selected from the Affiliated Drum Tower Hospital of Nanjing University Medical College,aged<80 years,body mass index(BMI)<30kg/m2,American Society of Anesthesiologists(ASA)physical status 1 to 3,all underwent total intravenous anesthesia.The patients' age,BMI,ASA grade,basic liver and kidney function,and combined disease were recorded before surgery.After the induction of anesthesia was completed,until the period before the incision(T1),after the start of pneumoperitoneum and Trendelenburg,before the end of the pneumoperitoneum(T2),and after the end of the pneumoperitoneum,the period from the supine position to the end of the operation(T3),the upper and lower limb blood pressure were measured every 10 minutes.Calculating the mean of the upper and lower limb blood pressure in each time period,and comparing the mean of the upper and lower limb blood pressure in different time periods by paired t test.Intraoperative upper and lower extremity blood pressure,central venous pressure,use of vasoactive drugs,blood transfusion,infusion volume,estimated blood loss and pneumoperitoneum time were recorded.According to the results of liver and renal function at postoperative day 1,the patients were divided into normal liver function group,abnormal liver function group and normal renal function group,abnormal renal function group.The risk factors of liver and kidney dysfunction were screened by binary logistic regression analysis.ResultsCompared with T1,upper limb SBP,DBP and MAP increased(P<0.001),lower limb SBP,DBP and MAP decreased during T2(P<0.001);compared with T1,no significant difference was found in upper limb SBP,DBP and MAP(P>0.05),lower extremity SBP decreased(P<0.05),lower extremity DBP and MAP decreased during T3(P<0.001).Compared with T2,upper limb SBP,DBP and MAP decreased(P<0.001),lower limb SBP,DBP and MAP elevated during T3(P<0.001),Univariate analysis showed that increased DBP in the upper extremity and decreased DBP in the lower extremity during T2 were risk factors for abnormal liver function in patients with RARP,Increased age,abnormal preoperative urea nitrogen,abnormal preoperative serum creatinine,abnormal estimated glomerular filtration rate(eGFR),intraoperative antihypertensive drugs,and increased blood loss were risk factors for abnormal renal function in patients with RARP.Multivariate analysis showed that DBP decreased in the lower extremity during T2(OR=3.210,95%CI:1.212-8.504,P=0.019)was an independent risk factor for postoperative liver dysfunctionin in RARP patients,increased age(OR=2.037,95%CI:1.006-4.126,P = 0.048),preoperative abnormal eGFR(OR=17.458,95%CI:4.590-66.410,P<0.001)and estimated blood loss(OR=5.690,95%CI:1.998-16.206,P=0.001)were independent risk factors for postoperative renal dysfunction in patients with RARP.ConclusionsAnomalous phenomenon occurs in blood pressure changes of upper and lower extremities in patients with RARP,upper limb blood pressure rises,lower limb blood pressure drops and lower than upper limb blood pressure.The change of DBP in the lower limb can be used as a predictor of postoperative liver dysfunction in patients with RARP.Age,preoperative eGFR and estimated blood loss can be used as early warning factors for postoperative renal dysfunction in patients with RARP.