七氟醚小流量半紧闭吸入麻醉对肾小管功能的影响

摘要

Objective To investigate the impact of low flow semi-closed inhalation anesthesia with Sevoflurane on renal tubular function. Methods 13 patients who had received the low flow semi-closed inhalation anesthesia with Sevoflurane in our hospital from 2005 to 2010 were selected. The preoperative, intraoperative and postoperative gamma -glutamine transpeptidase (GGT), β2 microglobulin (β2MG), N-acetyl-P-D-amino glucoside (NAG), alanine aminotransferase (ALT), aspartate aminotransferase (AST), creatinine (Cr), blood urea nitrogen (BUN) and other indicators were detected respectively, and the intraoperative sodium lime temperature of patients was monitored. Results The renal tubular function indicators including GGT, ALT, AST, Cre and BUN all reduced on different degrees during the operation, but returned to normal levels in 3 days after the operation, with insignificant differences between before and after operation. The renal tubular func -tion indicator NAG reached the highest level on the first day after operation [(5.13 ±0.87)U/(mmol·Cr)], and β2MG reached the highest level on the 3st day after operation [(24.83±4.97)mg/(mol·Cr)], with statistically significant differences between before and after operation for both indicators (P < 0.05). Conclusion The low flow semi-closed inhalation anesthesia with Sevoflurane has certain impact on the renal tubular function of patients, but has no significant impact on other renal functions, and therefore it is a safe and reliable method of anesthesia, thereby worthy of clinical promotion and appli -patients,%目的 探讨七氟醚小流量半紧闭吸入麻醉对肾小管功能的影响.方法 选取我院2005～2010年采用七氟醚小流量半紧闭吸入麻醉的患者13例,分别检测其术前、术中、术后的γ-谷氨酰胺转肽酶(gamma-glutamine transpeptidase,GGT)、β2-微球蛋白(β2 microglobulin,β2MG)、N-乙酰-β-D-氨基葡萄糖苷(N-acetyl-β-D-amino glucoside,NAG)、丙氨酸氨基转移酶(alanine aminotransferase,ALT)、天门冬氨酸氨基转移酶(aspartate aminotransferase,AST)、肌酐(creatinine,Cr)、尿素氮(blood urea nitrogen,BUN)等指标,且术中监测患者钠石灰温度.结果 所有患者手术前后肾小管功能指标GGT、ALT、AST、Cr、BUN 在术中均有不同程度的减小趋势,术后3 d 又回到正常水平,前后差异不显著,而肾小管功能指标尿NAG 在术后第1 天达到最高[(5.13±0.87)U/(mmol·Cr)],指标β2MG 在术后第3天达到最高[(24.83±4.97)mg/(mol·Cr)],两组指标在手术前后比较,差异有统计学意义(P < 0.05).结论 采用七氟醚小流量半紧闭吸入麻醉对患者肾小管重吸收功能有一定的影响,对其他肾功能的影响不明显,是一种安全可靠的麻醉方法,值得临床推广使用.