七氟烷麻醉或全凭静脉丙泊酚麻醉时患者肾功能的比较：一项单中心平行随机对照研究

七氟烷麻醉或全凭静脉丙泊酚麻醉时患者肾功能的比较：一项单中心平行随机对照研究

贵州医科大学     麻醉与心脏电生理课题组

翻译：佟睿  编辑：张中伟  审核：曹莹

罂 粟 摘 要  

背景：麻醉药物的选择可能会影响肾血流灌注和肾功能的调节。我们研究了使用丙泊酚或七氟烷麻醉的患者手术前和手术后的肾功能。

方法：研究纳入拟于丙泊酚或七氟烷麻醉下进行脊柱手术的ASA1~2级的患者。分别在麻醉前、麻醉期间(手术前)、术后护理期间和手术后第二天采集血液和尿液。

结果：研究纳入了27名患者(平均年龄51岁；平均体重指数28 kg/m2)，其中11名为女性。七氟烷麻醉时（n=14）患者尿量和钠排泄量均低于丙泊酚麻醉时（n=13）患者的尿量和钠排泄量(分别为0.3 vs 1.1ml·kg-1·h-1和2.6 vs 6.0mmol·h-1[P=0.04])。麻醉期间尿钾排泄量低于麻醉后，组间差异无统计学意义(2.3 vs 5.7mmolh-1，P<0.001)。七氟烷麻醉后较麻醉前血浆肾素升高(138 vs 23mIU L-1，P<0.001)，丙泊酚麻醉时血浆肾素升高(138 vs 27mIU L-1，P<0.008)。血浆精氨酸加压素在麻醉期间无明显变化，但与麻醉前相比术后升高(21 vs 12ng·L-1，P=0.02)。七氟烷组患者术后血肌酐高于丙泊酚组(83 vs 66mmol·L-1，P<0.01)。肾损伤分子-1和中性粒细胞明胶酶相关脂蛋白在两组中均无明显变化。

结论：与丙泊酚麻醉相比，七氟醚麻醉可减少尿量和钠排泄，增加血浆肾素。这对手术中急性肾损伤和液体复苏的影响值得进一步研究。

原始文献来源：Renal function during sevoflurane or total intravenous propofol anaesthesia: a single-centre parallel randomised controlled study.[J]Br J Anae,128 (5):  838-848 (2022).

英文原文   

Renal function during sevoflurane or total intravenous propofol anaesthesia: a single-centre parallel randomised controlled study

Abstract

Background: The choice of anaesthetic may influence regulation of renal perfusion and function. We investigated renal function in patients anaesthetised with propofol or sevoflurane before surgery and postoperatively.

Method: Patients with ASA physical status 1-2 planned for spinal surgery were randomised to propofol or sevoflurane anaesthesia. Blood and urine were collected before anaesthesia, during anaesthesia (before surgery), during postoperative care, and the day after surgery.

Results: Twenty-seven patients completed the study protocol (average age, 51 yr; average BMI, 28 kg m-2) and 11 were women. Urine output and sodium excretion were lower during sevoflurane anaesthesia (n=14) than during propofol anaesthesia (n=13) (0.3 vs 1.1 ml kg-1 h-1 [P=0.01] and 2.6 vs 6.0 mmol h-1 [P=0.04], respectively). Urinary potassium excretion was lower during anaesthesia than after, without intergroup difference (2.3 vs 5.7 mmol h-1, P<0.001). Sevoflurane anaesthesia increased plasma renin compared with baseline (138 vs 23 mIU L-1, P<0.001) and propofol anaesthesia (138 vs 27 mIU L-1, P=0.008). Plasma arginineevasopressin did not change significantly during anaesthesia, but was elevated postoperatively compared with baseline irrespective of anaesthetic (21 vs 12 ng L-1, P=0.02). Sevoflurane caused higher postoperative plasma creatinine than propofol (83 vs 66 mmol L-1, P=0.01). Kidney injury molecule-1 and neutrophil gelatinase-associated lipocalin did not change significantly in either group.

Conclusion: Sevoflurane anaesthesia reduced urine output and sodium excretion and increased plasma renin compared with propofol anaesthesia. The impact of this on acute kidney injury and fluid resuscitation during surgery warrants further investigation.

打赏