Nagata N, Agune T, Takeshita M, Yoshikawa G, Takasaki M
Department of Anesthesiology, Miyazaki Medical College.
Masui. 1993 Aug;42(8):1157-61.
Hypotensive anesthesia induced by trimethaphan was maintained at 70-79 mmHg of the systolic radial artery pressure for two hours in 35 patients undergoing spherical acetabul osteotomy. The creatinine clearance, free water clearance, fractional sodium excretion, urine volume, urinary excretion of NAG and levels of gamma-GTP, serum GOT and GPT were measured perioperatively. The creatinine clearance, free water clearance and urine volume decreased by 50% during surgery but recovered to normal values on the third day after surgery. The fractional sodium excretion remained unchanged during and after surgery. The urinary NAG activity increased from 3 +/- a (SD) to 10 +/- 5 U.g-1 and gamma-GTP activity increased from 23 +/- 7 to 33 +/- 13 U.g-1 during surgery, and these remained at high levels for three days after surgery. The serum GOT and GPT levels were within normal ranges for 21 postoperative days. The increase in urinary enzyme activities during and after surgery indicates that mild damage of renal tubular cells has occurred during hypotensive anesthesia.
在35例行球形髋臼截骨术的患者中,使用三甲噻方诱导的低血压麻醉将桡动脉收缩压维持在70 - 79 mmHg达两小时。在围手术期测量肌酐清除率、自由水清除率、钠排泄分数、尿量、NAG尿排泄量以及γ - GTP、血清谷草转氨酶(GOT)和谷丙转氨酶(GPT)水平。肌酐清除率、自由水清除率和尿量在手术期间下降了50%,但在术后第三天恢复到正常水平。钠排泄分数在手术期间及术后保持不变。手术期间尿NAG活性从3±a(标准差)增至10±5 U.g-1,γ - GTP活性从23±7增至33±13 U.g-1,且术后三天一直维持在高水平。血清GOT和GPT水平在术后21天内均在正常范围内。手术期间及术后尿酶活性增加表明在低血压麻醉期间发生了肾小管细胞的轻度损伤。