七氟烷及异氟烷麻醉对严重骨折术后肾功能损伤作用的研究  

Study of the effect of sevoflurane and isoflurane anesthesia on postoperative renal dysfunction of severe fracture

作　　者：胡成侠 张丽[2] 杨玉杰[3] 张素华[2] 

机构地区：[1]山东省海阳市人民医院麻醉科,265100 [2]山东省海阳市人民医院手术室,265100 [3]山东省海阳市人民医院妇科,265100

出　　处：《中国医师进修杂志》2012年第21期14-16,共3页Chinese Journal of Postgraduates of Medicine

摘　　要：目的探讨七氟烷及异氟烷麻醉对严重骨折术后肾功能的影响。方法共纳入62例严重骨折需要手术患者，均行全身麻醉。62例患者按随机数字表法分为七氟烷组（31例，麻醉维持给予1．5％～3．0％七氟烷）、异氟烷组（31例，麻醉维持给予1．5％-3．0％异氟烷），两组均静脉持续泵注雷米芬太尼0．1～0．2μg/kg·min），间断静脉注射阿曲库铵维持麻醉。比较两组术后血肌酐（SCr）、血尿素氮（BUN）的差异，同时比较两组患者术后需要行血液透析治疗的例数。结果两组术后第1、3、7天SCr、BUN水平均显著低于术前[七氟烷组：（517±187）、（163±110）、（103±99）μmol／L比（853±220）μmol／L，（17．1±7．8）、（9．5±4．1）、（9．7±3．8）mmol／L比（21．8±9．3）mmol]L；异氟烷组：（539±188）、（136±108）、（101±95）μmol／L比（881±220）μmol／L，（17．5±7．4）、（9．5±3．5）、（9．8±3．3）mmol／L比（20．0±8．9）mmol／L]，差异有统计学意义（P〈0．05）。术后各时间点SCr、BUN水平两组间比较差异无统计学意义（P〉0．05）。术后7d内七氟烷组有1例（3．2％）患者需要行血液透析治疗，异氟烷组亦有1例（3．2％）患者需要行血液透析治疗，两组比较差异无统计学意义（P〉0．05）。结论对于严重骨折行全身麻醉手术的患者，七氟烷与异氟烷均对肾功能无显著不良影响，因此对于此类患者使用七氟烷行麻醉治疗可行，值得临床推广应用。Objective To investigate the effect of sevoflurane and isoflurane anesthesia on the renal function of patients with severe fracture after surgery. Methods Sixty-two patients with severe fracture who needed surgery were enrolled and all received general anesthesia. All the patients were divided by random digits table method into two groups with 31 cases each：sevoflurane group （anesthesia maintenance with 1.5% -3.0% sevoflurane） and isoflurane group （anesthesia maintenance with 1.5%-3.0% isoflurane）. The patients in two groups received 0.1 - 0.2 μ g/（kg·min） remifentanil continuous intravenous infusion and atracurium intermittent intravenous injection for anesthesia maintenance. Serum creatinine （SCr） and blood urea nitrogen （BUN） in two groups after surgery were compared, as well as the number of hemodialysis. Results SCr and BUN at 1,3,7 d after surgery in two groups were significantly lower than those before surgery [seveflurane group： （517 ± 187）, （163 ± 110）, （103 ±99） μmol/L vs. （853 ±220） μmol/L, （17.1 ±7.8）, （9.5 ±4.1）, （9.7 ±3.8） mmol/L vs. （21.8 ±9.3） mmol/L;isoflurane group： （539 ± 188）, （136± 108）, （101 ±95） μmol/L vs. （881 ±220） μmol/L, （17.5 ± 7.4）, （9.5 ± 3.5）,（9.8 ±3.3） mmol/L vs. （20.0 ± 8.9） mmol/L]（P〈 0.05 ）. SCr and BUN between two groups at every time point after surgery had no statistical significance （P 〉 0.05）. There was 1 case （3.2%） in sevoflurane group needed hemodialysis within 7 d after surgery, as well as in isoflurane group, and there was no statistical significance between two groups（P 〉 0.05）. Conclusions For patients with severe fracture who need general anesthesia and surgery, sevoflurane and isoflurane both have no significant adverse reaction to renal function. Therefore,it is acceptable for the patients to use sevoflurane for anesthesia and it is worthy of clinical popularization and application.

关 键 词：骨折 七氟烷 异氟烷 肾功能 

分 类 号：R614[医药卫生—麻醉学]