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[术中补液对三甲噻方控制性降压麻醉期间肾功能的影响]

[Effect of intra-operative fluid on renal function during hypotensive anesthesia with trimethaphan].

作者信息

Endoh M, Takamura T, Shiga T, Ogawa R

机构信息

Department of Anesthesia, Kantoh Rosai Hospital, Kawasaki.

出版信息

Masui. 1996 Jan;45(1):15-20.

PMID:8865719
Abstract

During induced hypotensive anesthesia in 26 cases with trimethaphan, either Ringer's lactate solution (LR group) or 2/3 lactate-saline solution (2/3 LS group) was infused at the same rate. Urine volume, creatinine clearance (Ccr), FENa, urinary gamma-GTP index and urinary Na/K ratio were determined before hypotension, during hypotension and after the operation. During hypotension, FENa and urine Na/K ratio decreased in both groups. In 2/3 LS group, these remained low after the operation compared with the values before hypotension and in LR group. These results suggest that LR solution might depress an endocrine response which is induced by hypotensive anesthesia. As urine volume and Ccr were unchanged by hypotension, and infusion of colloid solution (Hespander) could not increase these figures, circulating blood volume might not be decreased during hypotensive anesthesia. Since urinary gamma-GTP index increased slightly during hypotension or after the operation, there might have been a slight epithelial cell damage of tubules with hypotensive anesthesia.

摘要

在26例使用三甲噻方进行控制性低血压麻醉的患者中,以相同速率输注乳酸林格液(LR组)或2/3乳酸盐 - 盐溶液(2/3 LS组)。在低血压前、低血压期间及术后测定尿量、肌酐清除率(Ccr)、滤过钠排泄分数(FENa)、尿γ - 谷氨酰转肽酶指数及尿钠/钾比值。低血压期间,两组的FENa和尿钠/钾比值均降低。与低血压前的值及LR组相比,2/3 LS组术后这些指标仍保持较低水平。这些结果提示,LR溶液可能抑制了控制性低血压麻醉诱导的内分泌反应。由于低血压未改变尿量和Ccr,且输注胶体溶液(贺斯)也未能增加这些数值,因此在控制性低血压麻醉期间循环血容量可能未减少。由于尿γ - 谷氨酰转肽酶指数在低血压期间或术后略有升高,控制性低血压麻醉可能对肾小管上皮细胞有轻微损伤。

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