Ramírez-Sánchez A, del Río C G, García-Torres L, Palacio-Rodríguez M A
Servicio de Anestesiología y Reanimación, Ciudad Sanitaria Virgen de las Nieves, Granada.
Rev Esp Anestesiol Reanim. 1995 Dec;42(10):407-11.
To study changes in kidney function immediately after abdominal or eye surgery and to assess the roles of vasoactive substances: antidiuretic hormone (ADH), renin and aldosterone and natriuretic factors (atrial natriuretic peptide [ANP] and digoxin-like immunoreactive factor [DLIF]) in renal function.
We distributed 23 patients into 2 groups. Group A contained 16 subjects undergoing high abdominal surgery (cholecystectomy) under general anesthesia, and group B included 7 patients undergoing cataract extraction and intraocular lens implantation with peribulbar anesthesia. The first blood sample was taken before anesthetic induction; the first urine sample had been taken 24 hours prior to surgery. The second blood and urine samples were taken 2 hours after the patient's arrival in the intensive care recovery ward.
Patients undergoing abdominal surgery experienced significant decreases in diuresis (p < 0.01) and sodium excretion (p < 0.05) and increases of potassium in urine (p < 0.01) and urinary osmolarity, accompanied by high ADN (p < 0.01) and aldosterone (p < 0.01) levels in both blood (p < 0.05) and urine. Renin, ANP and DLIF did not change significantly in patients receiving peribulbar anesthesia.
The increases in ADH and aldosterone levels that occur as a response to stress in abdominal surgery are implicated in the antidiuretic and antinatriuretic effects observed in the postoperative period. Renin, ANP and DLIF do not seem to be responsible for kidney dysfunction.
研究腹部手术或眼部手术后肾功能的即刻变化，并评估血管活性物质：抗利尿激素（ADH）、肾素、醛固酮及利钠因子（心房利钠肽[ANP]和洋地黄样免疫反应因子[DLIF]）在肾功能中的作用。
我们将23例患者分为2组。A组包含16例在全身麻醉下接受上腹部手术（胆囊切除术）的患者，B组包括7例在球周麻醉下接受白内障摘除及人工晶状体植入术的患者。第一份血样在麻醉诱导前采集；第一份尿样在手术前24小时采集。第二份血样和尿样在患者进入重症监护恢复病房2小时后采集。
接受腹部手术的患者尿量（p < 0.01）和钠排泄量（p < 0.05）显著降低，尿钾（p < 0.01）和尿渗透压升高，同时血液（p < 0.05）和尿液中的ADN（p < 0.01）及醛固酮（p < 0.01）水平升高。接受球周麻醉的患者肾素、ANP和DLIF无显著变化。
腹部手术应激导致的ADH和醛固酮水平升高与术后观察到的抗利尿和抗利钠作用有关。肾素、ANP和DLIF似乎与肾功能障碍无关。
