Stegmayr B G, Björck L, Kempi V, Semb H
Department of Internal Medicine, University Hospital, Umeå, Sweden.
Acta Orthop Scand. 1992 Feb;63(1):7-12. doi: 10.3109/17453679209154840.
To evaluate the importance of various changes during major surgery, 26 patients, electively chosen for total hip replacement (THR), were investigated for renal function preoperatively and postoperatively. In most of the patients, surgery was performed ad modum Charnley (n 25), and anesthesia was given mainly by continuous administration of bupivacaine or mepivacaine through an epidural catheter. Postoperatively, there was an improvement in glomerular filtration rate (GFR) and a reduction in renal concentrating ability (RCA), but no change in diurnal albumin excretion. No correlation was found between the change in GFR and, e.g., the degree of peroperative hypotension, bleeding, transfusions, or volume of infusions. There was a correlation between the impairment of RCA and the lowering of serum albumin concentration. In 3 patients the GFR was slightly impaired. The risk of contracting severe, acute renal failure seems low in THR performed on patients with reduced or normal kidney function.
为评估大手术期间各种变化的重要性，对26例择期行全髋关节置换术（THR）的患者进行了术前和术后肾功能调查。大多数患者采用Charnley术式（n = 25）进行手术，麻醉主要通过硬膜外导管持续给予布比卡因或甲哌卡因。术后，肾小球滤过率（GFR）有所改善，肾浓缩能力（RCA）降低，但日间白蛋白排泄无变化。未发现GFR变化与手术期间低血压程度、出血、输血或输液量等之间存在相关性。RCA损害与血清白蛋白浓度降低之间存在相关性。3例患者的GFR略有受损。对于肾功能减退或正常的患者，行THR时发生严重急性肾衰竭的风险似乎较低。
