Sharrock N E, Beksac B, Flynn E, Go G, Della Valle A Gonzalez
Department of Anesthesiology and Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Medical College of Cornell University, 535 East 70th Street, New York, NY 10021, USA.
Br J Anaesth. 2006 Feb;96(2):207-12. doi: 10.1093/bja/aei308. Epub 2005 Dec 23.
Hypotensive anaesthesia does not impair renal function after surgery in normal patients but there are no reports of hypotensive anaesthesia in patients with chronic renal dysfunction (CRD).
From a database of 1893 consecutive patients undergoing total hip replacement (THR) under hypotensive epidural anaesthesia (HEA) from 1999 to 2004, 54 patients were identified with CRD (preoperative serum creatinine > or =124 micromol litre(-1)). Fifty matched pairs were identified for patients with normal renal function who have hypertension (n=50) or no hypertension (n=50). Changes in serum creatinine and blood urea nitrogen (BUN) were recorded daily for 3 days. Acute renal failure was defined as an increase in serum creatinine of 44 micromol litre(-1).
The mean duration of hypotension (MAP<55 mm Hg) was 94 min (range 35-305 min). The mean age was 71 yr. All patients with a creatinine level of 124 micromol litre(-1) had a creatinine clearance of <40 ml min(-1) 1.73 m(-2) (range: 13-56). Patients with CRD received more crystalloid during surgery (1755 ml) than the other two groups (1435 ml) (P<0.001). Otherwise, all three groups were similar. No patients developed evidence of acute renal dysfunction immediately after or by 24 h after surgery. Three patients with CRD had an increase in creatinine of >44 micromol litre(-1) at 48 and 72 h after surgery in the setting of volume depletion (acute blood loss in two patients and early ileus in one). Renal function subsequently improved.
HEA, per se, when carefully managed does not appear to predispose patients with CRD to acute renal failure after THR.
低血压麻醉对正常患者术后肾功能无损害，但尚无慢性肾功能不全（CRD）患者接受低血压麻醉的报道。
从1999年至2004年在低血压硬膜外麻醉（HEA）下行全髋关节置换术（THR）的1893例连续患者的数据库中，确定54例CRD患者（术前血清肌酐≥124微摩尔/升）。为肾功能正常的高血压患者（n = 50）或无高血压患者（n = 50）确定50对匹配对照。连续3天每天记录血清肌酐和血尿素氮（BUN）的变化。急性肾衰竭定义为血清肌酐升高44微摩尔/升。
低血压（平均动脉压<55毫米汞柱）的平均持续时间为94分钟（范围35 - 305分钟）。平均年龄为71岁。所有肌酐水平为124微摩尔/升的患者肌酐清除率<40毫升/分钟·1.73平方米（范围：13 - 56）。CRD患者术中接受的晶体液量（1755毫升）多于其他两组（1435毫升）（P<0.001）。除此之外，三组情况相似。术后即刻或术后24小时内无患者出现急性肾功能不全的证据。3例CRD患者在术后48小时和72小时因容量不足（2例急性失血，1例早期肠梗阻）出现肌酐升高>44微摩尔/升。肾功能随后改善。
精心管理的HEA本身似乎不会使CRD患者在THR后易发生急性肾衰竭。
