Colson P, Capdevilla X, Barlet H, Séguin J R, Marty-Anè C, Roquefeuil B
Départment d'Anesthésie, Centre Hospitalier Universitaire, Hopital St-Eloi, Montpellier, France.
J Cardiothorac Vasc Anesth. 1992 Jun;6(3):295-8. doi: 10.1016/1053-0770(92)90143-u.
Aortic cross-clamping for reconstructive aortic surgery is associated with impairment of renal function. Halothane or isoflurane was used to assess the influence of volatile anesthesia on renal hemodynamics during aortic surgery. Nineteen patients with normal preoperative creatinine clearances who were scheduled for reconstructive aortic surgery were randomly divided into two groups: halothane group (n = 9) and isoflurane group (n = 10). Induction of anesthesia consisted of midazolam, fentanyl, and pancuronium. Anesthesia was maintained with fentanyl and halothane or isoflurane in nitrous oxide and oxygen (50/50). Systemic hemodynamics were similar in both groups throughout surgery. Before aortic cross-clamping, effective renal plasma flow (ERPF) (131I-hippuran clearance) and glomerular filtration rate (GFR) (99Tc-DTPA clearance) were significantly lower in the halothane group (118.4 +/- 25.6 and 19.7 +/- 5.2 mL/min, respectively) than in the isoflurane group (253.4 +/- 51.5 and 44.9 +/- 8.4 mL/min) (P less than 0.05 for both). During cross-clamping, the renal variables were not markedly affected in either group and remained higher in the isoflurane-anesthetized patients (232.9 +/- 47.1 and 49.5 +/- 1.2 mL/min for ERPF and GFR, respectively) than in the halothane-anesthetized patients (132.4 +/- 31.6 and 14.8 +/- 3.7 mL/min, respectively) (P less than 0.05). After aortic unclamping, ERPF increased markedly in both groups (467.8 +/- 122 and 362.5 +/- 57.7 mL/min in the halothane and isoflurane groups, respectively), as did GFR (74.8 +/- 22 and 71.8 +/- 13.1 mL/min, respectively). These results suggest that anesthesia with halothane is associated with transient renal vasoconstriction during abdominal surgery. In contrast, aortic cross-clamping during isoflurane anesthesia was not associated with renal hemodynamic impairment.
用于主动脉重建手术的主动脉交叉钳夹与肾功能损害有关。使用氟烷或异氟烷来评估挥发性麻醉对主动脉手术期间肾血流动力学的影响。将19例术前肌酐清除率正常且计划进行主动脉重建手术的患者随机分为两组：氟烷组（n = 9）和异氟烷组（n = 10）。麻醉诱导包括咪达唑仑、芬太尼和泮库溴铵。使用芬太尼和氟烷或异氟烷与氧化亚氮和氧气（50/50）混合维持麻醉。两组在整个手术过程中的全身血流动力学相似。在主动脉交叉钳夹前，氟烷组的有效肾血浆流量（ERPF）（131I-马尿酸清除率）和肾小球滤过率（GFR）（99Tc-DTPA清除率）显著低于异氟烷组（分别为118.4±25.6和19.7±5.2 mL/min）（分别为253.4±51.5和44.9±8.4 mL/min）（两者P均<0.05）。在交叉钳夹期间，两组的肾变量均未受到明显影响，异氟烷麻醉患者的肾变量（ERPF和GFR分别为232.9±47.1和49.5±1.2 mL/min）仍高于氟烷麻醉患者（分别为132.4±31.6和14.8±3.7 mL/min）（P<0.05）。主动脉松开钳夹后，两组的ERPF均显著增加（氟烷组和异氟烷组分别为467.8±122和362.5±57.7 mL/min），GFR也显著增加（分别为74.8±22和71.8±13.1 mL/min）。这些结果表明，氟烷麻醉与腹部手术期间短暂的肾血管收缩有关。相比之下，异氟烷麻醉期间的主动脉交叉钳夹与肾血流动力学损害无关。
