摘要
目的比较七氟醚、地氟醚紧闭循环麻醉下神经外科手术后病人肾功能的变化,评价七氟醚紧闭循环麻醉应用于临床的安全性。方法36例拟行神经外科手术病人,随机分为2组:七氟醚组(S组)和地氟醚组(D组),每组18例,新鲜气流量1-5 L/min洗入2-3 min,之后降低至0.18- 0.30L/min,七氟醚、地氟醚呼气末浓度分别维持在2.7%-4.0%、6.0%-10.0%。监测呼吸环路内氟甲基二氟乙烯醚(Compound A)浓度及吸入氧浓度。测定术前、术毕和术后2、24、72 h血清氟离子(F-)、肌酐(Cr)和尿素氮(BUN)浓度,测定术前、术毕和术后24、48、72 h尿中总蛋白(TP)、β2微球蛋白(β2-MG)和β-N-乙酰氨基葡萄糖苷酶(NAG)水平。结果在整个麻醉过程中病人吸入氧浓度不低于75%。术后两组血清Cr、BUN浓度及尿NAG/Cr与术前比较差异无统计学意义,组间比较差异无统计学意义。术后两组尿TP/Cr、β2-MG/Cr升高(P<0.05),组间比较差异无统计学意义。TP/Cr、β2-MG/Cr 与Compound A暴露量之间的相关系数分别为0.02、0.12(P>0.05)。结论七氟醚紧闭循环麻醉对神经外科手术后病人肾功能无影响。
Objective To compare the renal function after neurosurgery performed under closed-circuit anesthesia with sevoflurane and desflurane and determine the safety of the closed-circuit sevoflurane anesthesia. Methods 36 ASA Ⅰ or Ⅱ patients aged 18-60 years were randomly divided into 2 groups to receive either sevoflurane （group S, n=18） or desflurane （group D, n=18）. The duration of surgery was expected to be 990 min. The patients were premedicated with intramuscular midazolam 0.07 mg·kg^-1. Anesthesia was induced with midazolam 0.1 mg·kg^-1, fentanyl 1.5-2.0 μg·kg^-1, propofol 1-2 mg·kg^-1 and vecuronium 0.1-0.15 mg·kg^-1. The patients were mechanically ventilated （VT=8-12 ml·kg^-1） after tracheal intubation. PET CO2 was maintained a 35-45 mm Hg. Fresh gas flow （FGF） was first set at 1-5 L·min^-1 for 2-3 min, then reduced to 0.18-0.3 L·min^-1. In group D end-tidal desflurane concentration was maintained at 6%-10%; whereas in group S the end-tidal sevoflurane concentration was maintained at 2.7%-4.0%. BP, HR, ECG, SpO2 PETCO2, inspiratory and expiratory 02, desflurane and sevoflurane concentrations and the temperature in the center of soda-lime canister were continuously monitored during the operation. Gases were collected from breathing circuit for determination of compound A concentration （by gas chromatography） before anesthesia, at the end of 2-3 rain wash-in, every 30 min during maintenance of anesthesia and at the end of anesthesia. Venous blood samples were taken before anesthesia （baseline）, at the end of surgery （T1） and at 2, 24 and 72 h after operation （T2-4） for determination of serum F^- , creatinine （Cr） and blood urea nitrogen （BUN） concentrations. Urine specimens were taken for determination of total protein （TP）, β2-microglobulin （β2-MG） and β-N-acetyl-glucuronidase （NAG） levels, before operation （baseline） at the end of operation and at 24, 48 and 72 h after operation. TP/Cr, β2-MG/ Cr and NAG/Cr were calculated to eliminate the influence of the volume of urine. Results There were no significant differences between the two groups with respect to age, sex, body weight, height, duration of anesthesia and temperature in the center of soda-lime canister. The inspiratory O2 concentration was ≥75% during anesthesia. There was no significant difference in serum Cr and BUN concentrations and NAG/Cr in urine before and after operation as well as between the two groups. TP/Cr and β2-MG/Cr in urine were significantly increased after operation compared to the baseline values but there was no significant difference between the two groups. There was no significant correlation between postoperative TP/Cr, β-MG/Cr and compound A. Collusion Closedcircuit sevoflurane ansthesia does not affect postoperative renal function.
出处
《中华麻醉学杂志》
CAS
CSCD
北大核心
2005年第9期657-659,共3页
Chinese Journal of Anesthesiology
