Lema G, Urzua J, Jalil R, Canessa R, Moran S, Sacco C, Medel J, Irarrazaval M, Zalaquett R, Fajardo C, Meneses G
Department of Anesthesiology, Pontificia Universidad Católica de Chile, Santiago.
Anesth Analg. 1998 Jan;86(1):3-8. doi: 10.1097/00000539-199801000-00002.
We prospectively studied the effects of renal protection intervention in 17 patients with preoperative abnormal renal function (plasma creatinine > 1.5 mg/dL) scheduled for elective coronary surgery. Patients were randomized to either dopamine 2.0 micrograms.kg-1.min-1 (Group 1, n = 10) or perfusion pressure > 70 mm Hg during cardiopulmonary bypass (CPB) (Group 2, n = 7). Glomerular filtration rate and effective renal plasma flow were measured with inulin and 125I-hippuran clearances before the induction of anesthesia, after sternotomy and before CPB, during hypo- and normothermic CPB, after sternal closure, and 1 h postoperatively. Plasma and urine electrolytes were measured, and free water, osmolar, and creatinine clearances, as well as fractional excretion of sodium and potassium, were calculated before and after surgery. Significant differences between groups were found before CPB for glomerular filtration rate (higher in Group 1), urine output (2.0 vs 0.29 mL/min in Group 1 versus Group 2), urinary creatinine (66 vs 175 mg/dL), urinary osmolarity (370 vs 627 mOsm/L), osmolar clearance (2.1 vs 0.7 mL/min), and urinary potassium (33 vs 71 mEq/L). There were no differences between groups during hypo- and normothermic CPB. After CPB, the only difference was a slightly higher urinary creatinine in Group 2. Renal plasma flow was lower than normal in all patients before the induction of anesthesia. A nonsignificant trend toward increased flow was seen during hypothermic CPB. Filtration fraction was high before CPB, which suggests efferent arteriolar vasoconstriction, descending toward normal during and after CPB. The same pattern of changes was present in both groups. In conclusion, there were no clinically relevant differences between the two treatment modalities during and after CPB. However, significant differences were observed before CPB, when dopamine seemed to partially revert renal vasoconstriction.
Two protective interventions were compared in patients undergoing heart surgery to prevent deterioration of renal function; these were dopamine infusion throughout the operation and phenylephrine infusion during cardiopulmonary bypass. We found clinically relevant differences only during surgery before cardiopulmonary bypass.
我们前瞻性地研究了肾脏保护干预措施对17例计划进行择期冠状动脉手术且术前肾功能异常（血浆肌酐>1.5mg/dL）患者的影响。患者被随机分为两组，一组静脉输注多巴胺2.0微克·千克-1·分钟-1（第1组，n = 10），另一组在体外循环（CPB）期间灌注压>70mmHg（第2组，n = 7）。在麻醉诱导前、胸骨切开后及CPB前、低温和常温CPB期间、胸骨关闭后以及术后1小时，用菊粉和125I-马尿酸清除率测量肾小球滤过率和有效肾血浆流量。测量血浆和尿液电解质，并计算手术前后的自由水清除率、渗透压清除率和肌酐清除率，以及钠和钾的排泄分数。CPB前两组在肾小球滤过率（第1组较高）、尿量（第1组与第2组分别为2.0 vs 0.29mL/min）、尿肌酐（66 vs 175mg/dL）、尿渗透压（370 vs 627mOsm/L）、渗透压清除率（2.1 vs 0.7mL/min）和尿钾（33 vs 71mEq/L）方面存在显著差异。低温和常温CPB期间两组之间无差异。CPB后，唯一的差异是第2组尿肌酐略高。所有患者在麻醉诱导前肾血浆流量均低于正常。低温CPB期间可见流量增加的趋势，但无统计学意义。CPB前滤过分数较高，提示出球小动脉收缩，CPB期间及之后逐渐恢复正常。两组均呈现相同的变化模式。总之,CPB期间及之后两种治疗方式在临床上无显著差异。然而，CPB前观察到显著差异，此时多巴胺似乎部分逆转了肾血管收缩。
对心脏手术患者比较了两种肾脏保护干预措施以防止肾功能恶化；这两种措施分别是术中全程输注多巴胺和体外循环期间输注去氧肾上腺素。我们仅在体外循环前的手术过程中发现了具有临床意义的差异。
