老年胃肠道肿瘤患者术中输注氨基酸对术后肝肾功能的影响

摘要

背景与目的：以往研究显示，术中输注氨基酸可以缓解核心体温的降低。该研究旨在探讨术中输注氨基酸对硬膜外阻滞复合全麻下行胃肠道肿瘤手术老年患者术后肝肾功能的影响。方法：选择在硬膜外阻滞复合全麻下行胃肠道肿瘤手术的65～75岁患者40例，ASAⅠ～Ⅱ级，按随机数字表法随机分为2组：氨基酸干预组和0.9%氯化钠溶液组，各20例。分别在麻醉诱导同时输注11.4%复方氨基酸注射液2 mL·(kg·h)-1和0.9%氯化钠注射液2 mL·(kg·h)-1直至手术结束。记录诱导即刻、手术开始后90 min、关腹时鼻咽温度；查术前、术后第1天、术后第1周的肝肾功能指标：总胆红素(TBIL)、结合胆红素(DBIL)、总蛋白(TP)、白蛋白(ALB)、谷丙转氨酶(ALT)、谷草转氨酶(AST)、尿素(BUN)、肌酐(Scr)、尿酸(UA)。结果：手术开始后90 min及关腹即刻，氨基酸干预组鼻咽温度均高于0.9%氯化钠溶液组，两组比较差异有统计学意义(P<0.05)。两组各时间点肝肾功能指标均在正常范围内。两组组内比较，TBIL、DBIL在术后第1天均较术前升高(P<0.05)，但显著低于术后第1周(P<0.05)；TP、ALB在术后第1天、术后第1周均较术前降低(P<0.05)；ALT、AST在术后第1天、术后第1周较术前升高(P<0.05)；BUN在术后第1天较术前降低(P<0.05)；术后第1周Scr、UA较术前及术后第1天降低(P<0.05)；UA在术后第1天较术前降低(P<0.05)。但两组间比较，差异均无统计学意义(P>0.05)。结论：胃肠道肿瘤手术对老年患者术后肝肾功能有所影响，而术中输注氨基酸在改善麻醉手术引起的低温的同时不影响术后肝肾功能。%Background and purpose:Previous researches have shown that intravenous amino acid infusion during general anaesthesia prevents the decreases in core temperature. This study aimed to investigate the effect of amino acid infusion on postoperative liver and renal function in elderly patients undergoing gastrointestinal surgery. Methods:Forty ASAⅠ orⅡ patients (33 males, 7 females) aged 65-75 years undergoing elective gastrointestinal can-cer operation under epidural block combined with general anesthesia were randomly divided into 2 groups (n=20 each). GroupⅠ received intravenous infusion of mixed amino acids at a rate of 2 mL·(kg·h) -1 from induction of anesthesia to the end of operation (AA group); GroupⅡ received infusion of equal volume of normal saline (NS group). Snuff temperature was monitored for induction of anesthesia immediately, after 90 min and at closed abdomen. Renal and hepatic function was performed regularly before operation and on the 1st and 7th postoperative day.Results:The naso-pharyngeal temperatures at 90 min after the beginning of surgery and the time when the peritoneum was closed in AA group were signiifcantly higher than those in NS group (P<0.05). Hepatic and renal function indices were within the normal range in the AA and NS groups. There were signiifcant increases in TBIL, DBIL, ALT, and AST (P<0.05) after operation, whereas TP, ALB, BUN, Scr and UA decreased signiifcantly (P<0.05). There were no signiifcant differences in hepatic and renal function indices between the AA and NS groups (P>0.05).Conclusion:Intraoperative amino acid infusion has no signiifcant effects on the renal or hepatic function in elderly patients undergoing gastrointestinal surgery.