布洛芬不会损害接受硬膜外麻醉的肾下主动脉手术患者的肾功能。

Ibuprofen does not impair renal function in patients undergoing infrarenal aortic surgery with epidural anaesthesia.

作者信息

Brinkmann A, Seeling W, Wolf C F, Kneitinger E, Vogt N, Steinbach G, Orend K H, Radermacher P, Georgieff M

机构信息

University Clinics Ulm, Department of Anaesthesiology, Germany.

出版信息

Intensive Care Med. 1998 Apr;24(4):322-8. doi: 10.1007/s001340050574.

DOI:10.1007/s001340050574

PMID:9609409

Abstract

OBJECTIVE

To investigate the effect of preoperative ibuprofen administration on renal function during and after infrarenal aortic surgery under thoracolumbar epidural anaesthesia (EPA).

DESIGN

A prospective randomised, double-blinded clinical study.

SETTING

Operation room and intensive care unit in a university hospital.

PATIENTS

Twenty-six consecutive patients scheduled for elective infrarenal aortic surgery.

INTERVENTIONS

The patients were prospectively randomised to receive 400 mg ibuprofen intravenously (i.v.) or a placebo aliquot before surgery.

MEASUREMENTS AND RESULTS

We assessed renal function by calculating creatinine clearance, and fractional sodium excretion before surgery (baseline), 1 h after cross-clamping (intraoperative), 6 h after cross-clamping (postoperative) and 24 h after cross-clamping (on the 1 st postoperative day). At each point in time, we additionally registered haemodynamics and determined the plasma concentration of 6-keto-PGF1alpha (stable metabolite of prostacyclin, PGI2), bicyclic PGE2 (stable metabolite of PGE1 E2), active renin, aldosterone and vasopressin by radioimmunoassays. Throughout the observation period the renal function parameters mostly remained within the normal range without a significant difference between ibuprofen- and placebo-treated patients (creatinine clearance: baseline 41 +/- 3 vs 38 +/- 6, intraoperative 57 +/- 8 vs 64 +/- 11, postoperative 64 +/- 9 vs 56 +/- 9, first postoperative day 43 +/- 5 vs 47 +/- 6 ml x min x m(-2), means +/- SEM). The plasma levels of 6-keto-PGF1alpha (68 +/- 8 vs 380 +/- 71* ng x l(-1)), bicyclic PGE2 (57 +/- 5 vs 88 +/- 9* ng x l(-1)) and vasopressin (14 +/- 7 vs 45 +/- 10* ng x l(-1), p < 0.0125), however, were significantly higher during the intraoperative period in the placebo-treated patients.

CONCLUSION

The inhibition of endogenous prostaglandin release by ibuprofen does not substantially impair renal function during infrarenal aortic surgery under EPA.

摘要

目的

研究术前给予布洛芬对胸腰段硬膜外麻醉（EPA）下行肾下腹主动脉手术期间及术后肾功能的影响。

设计

一项前瞻性随机双盲临床研究。

地点

大学医院的手术室和重症监护病房。

患者

26例连续安排行择期肾下腹主动脉手术的患者。

干预措施

患者被前瞻性随机分为术前静脉注射400mg布洛芬或等量安慰剂。

测量与结果

我们通过计算肌酐清除率以及在手术前（基线）、阻断血管1小时后（术中）、阻断血管6小时后（术后）和阻断血管24小时后（术后第1天）的尿钠排泄分数来评估肾功能。在每个时间点，我们还记录血流动力学，并通过放射免疫分析法测定6-酮-前列环素F1α（前列环素PGI2的稳定代谢产物）、双环前列腺素E2（前列腺素E1 E2的稳定代谢产物）、活性肾素、醛固酮和血管加压素的血浆浓度。在整个观察期内，肾功能参数大多保持在正常范围内，布洛芬治疗组和安慰剂治疗组之间无显著差异（肌酐清除率：基线时分别为41±3和38±6，术中分别为57±8和64±11，术后分别为64±9和56±9，术后第1天分别为43±5和47±6 ml·min·m⁻²，均值±标准误）。然而，安慰剂治疗组患者术中6-酮-前列环素F1α（68±8 vs 380±71* ng·l⁻¹）、双环前列腺素E2（57±5 vs 88±9* ng·l⁻¹）和血管加压素（14±7 vs 45±10* ng·l⁻¹，p<0.0125）的血浆水平显著更高。