[罂粟摘要]七氟烷或丙泊酚在麻醉期间对肾功能的影响：一项单中心平行随机对照研究

七氟烷或丙泊酚在麻醉期间对肾功能的影响：一项单中心平行随机对照研究

贵州医科大学  麻醉与心脏电生理课题

翻译:  柏雪       编辑:  严旭  审校: 曹莹

背景:麻醉剂的选择可能会影响肾灌注和功能的调节。我们调查了术前和术后使用丙泊酚或七氟烷麻醉的患者的肾功能。

方法:计划进行脊柱手术 ASA 分级为 I-II级 的患者被随机分配至丙泊酚组或七氟烷组。在麻醉前、麻醉期间（手术前）、术后护理期间和手术后第二天收集血液和尿液。

结果:27 名患者完成了研究方案（平均年龄 为51 岁；平均 BMI，28 kg/ m ²），其中 11 名是女性。七氟烷组麻醉期间的尿量和钠排泄量 ( n =14) 低于丙泊酚组 ( n =13) (分别是0.3 vs 1.1 ml /kg/h [ P =0.01] 和 2.6 vs 6.0 mmol /h  [ P = 0.04]）。麻醉期间尿钾排泄低于麻醉后，无组间差异（2.3 vs 5.7 mmol /h , P<0.001)。与基线相比（138 vs 23 mIU L ^-1，P <0.001）和丙泊酚组（138 vs 27 mIU L ^-1，P = 0.008）相比，七氟烷组增加了血浆肾素。血浆精氨酸-加压素在麻醉期间没有显著变化，但术后与基线相比升高，与麻醉无关（21 vs 12 ng/ L，P = 0.02）。七氟烷导致术后血浆肌酐高于丙泊酚（83 vs 66 mmol /L , P=0.01)。肾损伤分子-1 和中性粒细胞明胶酶相关的脂质运载蛋白在两组中均未发生显着变化。

结论:与丙泊酚麻醉相比，七氟烷麻醉减少了尿量和钠排泄，增加了血浆肾素。这对手术期间急性肾损伤和液体复苏的影响值得进一步研究。

原始文献来源  ：

Stephanie Franzen, Egidijus Semenas, Micael Taavo,er,al. Renal function during sevoflurane or total intravenous propofol anaesthesia: a single-centre parallel randomised controlled study. British Journal of Anaesthesia.

英文原文：

Renal function during sevoflurane or total intravenous propofol anaesthesia: a single-centre parallel randomised controlled study

Background:The choice of anaesthetic may influence regulation of renal perfusion and function. We investigated renal function in patients anaesthetised with propofol or sevoflurane before surgery and postoperatively.

Methods:Patients with ASA physical status 1–2 planned for spinal surgery were randomised to propofol or sevoflurane anaesthesia. Blood and urine were collected before anaesthesia, during anaesthesia (before surgery), during postoperative care, and the day after surgery.

Results:Twenty-seven patients completed the study protocol (average age, 51 yr; average BMI, 28 kg m⁻²) and 11 were women. Urine output and sodium excretion were lower during sevoflurane anaesthesia (n=14) than during propofol anaesthesia (n=13) (0.3 vs 1.1 ml kg⁻¹ h⁻¹ [P=0.01] and 2.6 vs 6.0 mmol h⁻¹ [P=0.04], respectively). Urinary potassium excretion was lower during anaesthesia than after, without intergroup difference (2.3 vs 5.7 mmol h⁻¹, P<0.001). Sevoflurane anaesthesia increased plasma renin compared with baseline (138 vs 23 mIU L⁻¹, P<0.001) and propofol anaesthesia (138 vs 27 mIU L⁻¹, P=0.008). Plasma arginine–vasopressin did not change significantly during anaesthesia, but was elevated postoperatively compared with baseline irrespective of anaesthetic (21 vs 12 ng L⁻¹, P=0.02). Sevoflurane caused higher postoperative plasma creatinine than propofol (83 vs 66 mmol L⁻¹, P=0.01). Kidney injury molecule-1 and neutrophil gelatinase-associated lipocalin did not change significantly in either group.

Conclusions:Sevoflurane anaesthesia reduced urine output and sodium excretion and increased plasma renin compared with propofol anaesthesia. The impact of this on acute kidney injury and fluid resuscitation during surgery warrants further investigation.