丙泊酚和乌司他丁在腹腔镜手术中肾功能保护的临床研究  

Protective Effects of Ulinastatin and Propofol on Renal Function during Laparoscopic Surgery

作　　者：冯梅[1] 蒋宗滨[1] 冯秋云[1] 李爱国[1] 赵桂林[1] 张明明[1] 

机构地区：[1]广西医科大学第一附属医院西院手术室麻醉科,南宁市530007

出　　处：《广西医学》2014年第1期53-55,71,共4页Guangxi Medical Journal

摘　　要：目的：探讨异氟醚联合乌司他丁或丙泊酚对长时间腹腔镜手术中肾功能的影响。方法行腹腔镜腹部手术的患者60例，按随机数字表法分为A、B、C组，每组20例。在麻醉诱导后开始持续给予：A组异氟醚，B组异氟醚联合乌司他丁，C组异氟醚联合丙泊酚。记录患者气腹前（ T0）、注气后120 min（ T1）、240 min （T2）、术毕60 min（T3）、术后第1天（T4）、第2天（T5）和第3天（T6）时点的平均动脉压（MAP）、心率（HR）、指脉氧饱和度（ SpO2）、血气分析值、血尿素氮（ BUN）、血肌酐（ Cr）、输液量、出血量及尿量等。结果3组患者各时点的HR、MAP、血红蛋白、输液量、出血量或引流量及尿量比较，差异无统计学意义（ P＞0．05）；3组Cr、BUN水平比较，差异有统计学意义（P＜0．05）；与T0比较，3组患者T1～T5各时点BUN、Cr均增高（P＜0．05）；B组和C组的BUN、Cr低于A组（P＜0．05），但B、C两组之间比较，差异无统计学意义（P＞0．05）。结论 CO2气腹导致肾功能的变化随着气腹时间的延长而加重，术后不能很快恢复；异氟醚联合乌司他丁或丙泊酚对肾功能保护作用优于单独应用异氟醚，而前两者效果相当。Objective To observe the protective effects of ulinastatin or propofol combined with isoflurane on patients′renal function during a long-time laparoscopic surgery .Methods Sixty patients underwent elective laparoscopic operation of abdominal region were randomly divided into three groups A ,B,and C according to the random table ,20 cases in each group.Group A was given isoflurane ,group B was given isoflurane and ulinastatin ,group C was given isoflurane and propofol after anesthesia induction.Mean arterial pressure（MAP）,heart rate（HR）,SpO2 ,blood gas analysis,blood urea nitrogen （BUN）,creatinine（Cr）,the amount of transfusion,blood loss and urinary output were monitored before anesthesia （T0 ）,at 180 minutes（T1 ）,240 minutes（T2 ） after insufflation,60 minutes（T3 ） after operation,1（T4 ）,2（T5 ）,and 3 days（T6 ） after operation. Results There was no significant difference in HR,MAP,hemoglobin（Hb）,the amount of transfusion or drainage, blood loss and urinary output among three groups at different time-points（P〉0.05）;But Cr and BUN showed a significant difference among three groups（P〈0.05）.BUN and Cr at T1,T2,T3,T4,T5,T6 increased significantly compared with those at T0 among three groups （ P〈0 .05 ）;BUN and Cr in groups B and C were significantly lower than those in group A （P〈0.05）;But BUN and Cr showed no significant difference between group B and C （P〉0.05）.Conclusion The damage of CO 2 pneumoperitoneum on renal function increases with the extension of time and can not recover soon after operation.The protective effects of ulinastatin or propofol combined with isoflurane on renal function are better than that of isoflurane alone ,and the two former have the similar effects .

关 键 词：全身麻醉 肾功能 腹腔镜手术 丙泊酚 乌司他丁 二氧化碳气腹 

分 类 号：R971.94[医药卫生—药品]