Wahlström O, Maller R, Larsson R, Kågedal B
Department of Orthopaedic Surgery, University Hospital, Faculty of Health Sciences, Linköping, Sweden.
Scand J Infect Dis. 1992;24(1):85-8. doi: 10.3109/00365549209048405.
In a prospective pilot study 70 patients (age greater than 65 years) who underwent hip arthroplasty were treated with dicloxacillin, a total of 6 g given pre-, per- and postoperatively as antibiotic prophylaxis. Creatinine in serum and beta 2-microglobulin in serum and urine were determined as estimates of renal function. Values were obtained preoperatively and on days 2, 4 and 10 after operation. A slight but significant increase of serum creatinine was seen on day 2 with a gradual decrease almost down to the preoperative baseline value on day 10. Serum beta 2-microglobulin increased more gradually; the increase was significant on day 10. Raised levels of beta 2-microglobulin in urine were most pronounced: a 20-fold increase on day 2, then a slow decrease, still significant increase on day 10. This may indicate a reversible damage of proximal tubules with blocked tubular reabsorption of beta 2-microglobulin. The slightly increased levels of serum creatinine and beta 2-microglobulin would also indicate a minor reversible decrease in glomerular filtration rate. Whether these effects are caused by the operation trauma per se or by the dicloxacillin prophylaxis cannot be determined from this pilot study. It seems quite clear that hip arthroplasty with short term prophylaxis with dicloxacillin does not result in clinically important changes in renal function.
在一项前瞻性试点研究中，70例（年龄大于65岁）接受髋关节置换术的患者接受双氯西林治疗，术前、术中及术后共给予6g作为抗生素预防用药。测定血清肌酐以及血清和尿液中的β2-微球蛋白以评估肾功能。在术前以及术后第2、4和10天获取数值。术后第2天血清肌酐出现轻微但显著的升高，到第10天逐渐下降，几乎降至术前基线值。血清β2-微球蛋白升高较为缓慢；在第10天升高显著。尿中β2-微球蛋白水平升高最为明显：术后第2天升高20倍，随后缓慢下降，在第10天仍有显著升高。这可能表明近端肾小管存在可逆性损伤，伴有β2-微球蛋白的肾小管重吸收受阻。血清肌酐和β2-微球蛋白水平的轻微升高也表明肾小球滤过率有轻微的可逆性下降。从这项试点研究无法确定这些影响是由手术创伤本身还是双氯西林预防用药引起的。很明显，短期使用双氯西林进行预防的髋关节置换术不会导致肾功能出现具有临床意义的变化。
