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一项关于麻醉剂对体外循环心脏手术中肾功能影响的随机对照试验。

A randomized controlled trial on the impact of anesthetic agents on renal function in cardiac surgery with cardiopulmonary bypass.

作者信息

Fan Teng, Zhao Zhili, Liu Jun, Ma Wenke, Tian Jianmin, Ma Guifang

机构信息

The First Affiliated Hospital of Xinxiang Medical University, Henan, China.

出版信息

Mol Cell Biochem. 2025 Jun 6. doi: 10.1007/s11010-025-05326-8.

Abstract

Acute kidney injury (AKI) is a frequent and severe problem following heart surgery, particularly in procedures involving cardiopulmonary bypass (CPB). This research investigates the Randomized Controlled Trial (RCT) on the impact of agents of anesthetic on renal function in patients receiving elective cardiac surgery and CPB, comparing propofol-based and volatile anesthetic-based regimens. A sum of 61 patients was randomly assigned into two regions: one receiving a propofol-based regimen and the other, a volatile anesthetic regimen, both combined with opioid analgesia. Renal function was assessed preoperatively and postoperatively at 24 and 48 h using serum creatinine and cystatin C levels. Perioperative inflammatory markers were deliberate to evaluate inflammation-mediated renal impairment multivariate logistic regression identified risk factors for AKI, and independent t-tests compared renal function parameters between regimens. Patients receiving propofol exhibited significantly lower rates of AKI ( ) and reduced inflammatory marker levels associated to the volatile anesthetic regimen. These results present that propofol anesthesia provides a protecting influence on renal function, likely due to its anti-inflammatory properties. The research emphasizes the necessity of choosing the right anesthetic for postoperative kidney outcomes by tailoring anesthetic regimens to mitigate AKI risk in high-risk populations. Propofol's protective role against AKI offers potential clinical value, particularly in cardiac surgeries requiring CPB. Further investigation with bigger cohorts and continued follow-up are necessary for verifying these findings and exploring their broader applicability in cardiac anesthesia.

摘要

急性肾损伤(AKI)是心脏手术后常见且严重的问题,尤其是在涉及体外循环(CPB)的手术中。本研究调查了关于麻醉药物对接受择期心脏手术和CPB的患者肾功能影响的随机对照试验(RCT),比较了丙泊酚麻醉方案和挥发性麻醉剂麻醉方案。61名患者被随机分为两组:一组接受丙泊酚麻醉方案,另一组接受挥发性麻醉剂麻醉方案,两组均联合使用阿片类镇痛药。使用血清肌酐和胱抑素C水平在术前以及术后24小时和48小时评估肾功能。评估围手术期炎症标志物以评估炎症介导的肾功能损害,多因素逻辑回归确定AKI的危险因素,独立t检验比较不同方案之间的肾功能参数。接受丙泊酚麻醉的患者AKI发生率显著较低( ),且与挥发性麻醉剂麻醉方案相关的炎症标志物水平降低。这些结果表明,丙泊酚麻醉对肾功能具有保护作用,可能归因于其抗炎特性。该研究强调了通过调整麻醉方案以降低高危人群中AKI风险,从而为术后肾脏转归选择合适麻醉药物的必要性。丙泊酚对AKI的保护作用具有潜在临床价值,尤其在需要CPB的心脏手术中。需要更大样本量的进一步研究和持续随访以验证这些发现,并探索其在心脏麻醉中更广泛的适用性。

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