[替米沙坦对腹腔镜手术中肾小球滤过的影响。一项双盲随机对照研究]

[Impact of telmisartan on glomerular filtration in laparoscopic surgery. A double blinded randomised controlled study].

作者信息

Fuentes-Reyes Rodolfo Alejandro, Pacheco-Patiño Mariel Fernanda, Ponce-Escobedo Aurora Natalia, Muñoz-Maldonado Gerardo Enrique, Hernandez-Guedea Marco Antonio

机构信息

Servicio de Cirugía General, Hospital Universitario Dr. José Eleuterio González, Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, México.

出版信息

Cir Cir. 2017 Jan-Feb;85(1):34-40. doi: 10.1016/j.circir.2016.05.010. Epub 2016 Jul 12.

DOI:10.1016/j.circir.2016.05.010

PMID:27417705

Abstract

BACKGROUND

Laparoscopic surgery has begun to replace a great number of procedures that were previously practiced using open or conventional techniques. This is due to the minimal invasion, small incisions, and short time recovery. However, it has come to knowledge, that the increase in intra-abdominal pressure due to carbon dioxide pneumoperitoneum during laparoscopic surgery causes cardiovascular, respiratory, endocrine, and renal alterations.

OBJECTIVE

To evaluate the nephroprotective effect of telmisartan, an angiotensin II AT1 receptor antagonist, on glomerular filtration in laparoscopic surgery.

MATERIAL AND METHODS

Analytical prospective, randomised, double-blind study was conducted on patients undergoing elective laparoscopic cholecystectomy. They were randomised into 2 groups, with the treatment group receiving a single dose of 40mg telmisartan orally 2hours prior to surgery, and the placebo group.

RESULTS

There were 20 patients in each group (n=40), with a mean age of 32.65 years in the treatment group. Plasma creatinine did not show any significant change in the different time lapse in which blood samples were taken, but creatinine clearance at the end of surgery (196.415±56.507 vs. 150.1995±75.081; p=0.034), and at 2 h postoperative period (162.105±44.756 vs. 113.235±31.228; p≤0.001) was statistically significant, which supports an increase in renal function in the telmisartan group.

CONCLUSION

The use of telmisartan, an angiotensin II AT1 receptor antagonist, offers renal protection during laparoscopic surgery.

摘要

背景

腹腔镜手术已开始取代大量以前采用开放或传统技术实施的手术。这归因于其微创、切口小和恢复时间短。然而，现已了解到，腹腔镜手术期间因二氧化碳气腹导致的腹内压升高会引起心血管、呼吸、内分泌和肾脏方面的改变。

目的

评估血管紧张素II AT1受体拮抗剂替米沙坦对腹腔镜手术中肾小球滤过的肾保护作用。

材料与方法

对接受择期腹腔镜胆囊切除术的患者进行前瞻性、随机、双盲分析研究。将他们随机分为2组，治疗组在手术前2小时口服单剂量40mg替米沙坦，另一组为安慰剂组。

结果

每组有20例患者（n = 40），治疗组的平均年龄为32.65岁。血浆肌酐在采集血样的不同时间间隔内未显示任何显著变化，但手术结束时的肌酐清除率（196.415±56.507对150.1995±75.081；p = 0.034）以及术后2小时（162.105±44.756对113.235±31.228；p≤0.001）具有统计学意义，这支持替米沙坦组的肾功能有所增加。