Fredman B, Zohar E, Golan E, Tillinger M, Bernheim J, Jedeikin R
Department of Anesthesiology and Intensive Care, Meir Hospital, Kfar Saba, Israel.
Anesth Analg. 1999 Jan;88(1):149-54. doi: 10.1097/00000539-199901000-00028.
Nonsteroidal antiinflammatory drugs (NSAIDs) have become increasingly popular in the treatment of perioperative pain. Due to concerns that cyclooxygenase inhibition may adversely affect renal function, these drugs are often not used in geriatric surgical patients. However, the perioperative effect of NSAIDs on renal blood flow (RBF) and glomerular filtration rate (GFR) has not been assessed. Therefore, using a prospective, controlled, double-blinded study design, we evaluated the effect of diclofenac on RBF and GFR in 20 patients (>65 yr) undergoing open reduction and internal fixation of the femur. All patients were normovolemic before the study. A standardized general anesthetic was administered. On induction of anesthesia, patients in the diclofenac group received an IV bolus of diclofenac (0.7 mg/kg) followed by a constant infusion (0.15 mg x kg(-1) x h(-1)) until the end of surgery. In the saline group, an equal volume of saline was administered. During four time periods (equilibration, anesthesia, surgical, recovery), GFR and effective renal plasma flow (ERPF) were measured by inulin and paraaminohippurate clearance, respectively. After the induction of anesthesia and throughout the surgical period, ERPF and GFR were significantly decreased compared with preoperative baseline values. However, no difference was demonstrated between the groups. These results suggest that, in geriatric surgical patients, the adjuvant administration of NSAIDs does not adversely affect renal function.
As determined by inulin and paraaminohippurate clearance, the intraoperative administration of diclofenac does not decrease glomerular filtration rate or effective renal plasma flow in normovolemic geriatric patients. Therefore, diclofenac may be administered during the perioperative period.
非甾体抗炎药（NSAIDs）在围手术期疼痛治疗中越来越受欢迎。由于担心环氧化酶抑制可能对肾功能产生不利影响，这些药物通常不在老年外科患者中使用。然而，NSAIDs对肾血流量（RBF）和肾小球滤过率（GFR）的围手术期影响尚未得到评估。因此，我们采用前瞻性、对照、双盲研究设计，评估了双氯芬酸对20例（>65岁）接受股骨切开复位内固定术患者的RBF和GFR的影响。所有患者在研究前血容量正常。给予标准化全身麻醉。麻醉诱导时，双氯芬酸组患者静脉注射一剂双氯芬酸（0.7mg/kg），随后持续输注（0.15mg·kg⁻¹·h⁻¹）直至手术结束。生理盐水组给予等量生理盐水。在四个时间段（平衡期、麻醉期、手术期、恢复期），分别通过菊粉和对氨基马尿酸清除率测量GFR和有效肾血浆流量（ERPF）。麻醉诱导后及整个手术期间，与术前基线值相比，ERPF和GFR显著降低。然而，两组之间未显示出差异。这些结果表明，在老年外科患者中，辅助使用NSAIDs不会对肾功能产生不利影响。
通过菊粉和对氨基马尿酸清除率测定，在血容量正常的老年患者中，术中给予双氯芬酸不会降低肾小球滤过率或有效肾血浆流量。因此，双氯芬酸可在围手术期使用。
