患者对低流量地氟烷、七氟烷和丙泊酚的肾脏反应。

Renal responses to low-flow desflurane, sevoflurane, and propofol in patients.

作者信息

Ebert T J, Arain S R

机构信息

Department of Anesthesiology, Medical College of Wisconsin and Veterans Affairs Medical Center, Milwaukee 53295, USA.

出版信息

Anesthesiology. 2000 Dec;93(6):1401-6. doi: 10.1097/00000542-200012000-00010.

DOI:10.1097/00000542-200012000-00010

PMID:11149433

Abstract

BACKGROUND

The contributing factors that result in significant, postoperative proteinuria and glucosuria after low-flow isoflurane and sevoflurane anesthesia are unknown. The present study compared renal responses after anesthesia with desflurane (negligible metabolism), sevoflurane, or intravenous propofol.

METHODS

Informed consent was obtained from 52 patients with American Society of Anesthesiologists physical status I-III (aged 36-81 yr). Patients with diabetes or renal insufficiency were excluded. Desflurane (n = 20) or sevoflurane (n = 22), without nitrous oxide, was given at 1 l/min fresh gas flow for elective surgical procedures lasting more than 2 h; 10 patients received propofol without nitrous oxide as the primary anesthetic. Blood and urine chemistries were obtained before surgery. Blood and 24-h urine collections were obtained for 3 days after surgery and were analyzed for liver and renal indices.

RESULTS

Length of surgery averaged approximately 300 min (range, 136-750 min), minimum alveolar concentration-hour averaged 4.3 (range, 1.2-11.0), and infusion rates of propofol were 99-168 microg x kg(-1) x min(-1). Plasma creatinine concentration did not change, plasma blood urea nitrogen decreased significantly, and significant increases in urine glucose, protein, and albumin occurred similarly in all groups. Mean (+/- SD) postoperative urine glucose values for day 1 after desflurane, sevoflurane, and propofol were 1.4 +/- 3.0, 1.1 +/- 2.1, and 1.9 +/- 2.6 g/d (normal, < 0.5 g/d). The average daily protein/creatinine ratios for postoperative days 2-3 after desflurane, sevoflurane, and propofol were 240 +/- 187, 272 +/- 234, and 344 +/- 243 (normal, < 150 mg/g). Regardless of anesthetic, there were significantly greater urine protein concentrations after surgical procedures in central versus peripheral regions.

CONCLUSIONS

Alterations in postoperative renal function were common and unrelated to the choice of anesthetic. These findings implicate nonanesthetic factors in producing changes in biochemical indices of renal excretory function.

摘要

背景

低流量异氟烷和七氟烷麻醉后导致显著术后蛋白尿和糖尿的相关因素尚不清楚。本研究比较了地氟烷（代谢可忽略不计）、七氟烷或静脉注射丙泊酚麻醉后的肾脏反应。

方法

获得52例美国麻醉医师协会身体状况I-III级（年龄36-81岁）患者的知情同意。排除糖尿病或肾功能不全患者。地氟烷组（n = 20）或七氟烷组（n = 22），在无氧化亚氮的情况下，以1 l/min新鲜气流用于持续超过2小时的择期手术；10例患者接受无氧化亚氮的丙泊酚作为主要麻醉剂。术前采集血液和尿液进行生化检查。术后3天采集血液和24小时尿液，分析肝肾功能指标。

结果

手术时间平均约300分钟（范围136-750分钟），最低肺泡浓度-小时平均为4.3（范围1.2-11.0），丙泊酚输注速率为99-168μg·kg⁻¹·min⁻¹。血浆肌酐浓度无变化，血浆尿素氮显著下降，所有组尿葡萄糖、蛋白质和白蛋白均显著增加。地氟烷、七氟烷和丙泊酚麻醉后第1天的平均（±标准差）术后尿葡萄糖值分别为1.4±3.0、1.1±2.1和1.9±2.6 g/d（正常，<0.5 g/d）。地氟烷、七氟烷和丙泊酚麻醉后第2-3天的平均每日蛋白质/肌酐比值分别为240±187、272±234和344±243（正常，<150 mg/g）。无论采用何种麻醉方式，手术操作后中央区域的尿蛋白浓度均显著高于外周区域。