七氟醚与异丙酚复合麻醉对小儿活体肝移植术后急性肾损伤影响的比较  

Comparison in effects of propofol and sevoflurane on acute kidney injury in infants undergoing pediatric living donor liver transplantation

作　　者：李红霞[1] 喻文立[1] 贾莉莉[1] 郑磊 李静[2] LI Hongxia;YU Wenli;JIA Lili;ZHENG Lei;LI Jing(Tianjin First Center Hospital,Tianjin 300192,China)

机构地区：[1]天津市第一中心医院,天津300192 [2]天津市大港医院

出　　处：《山东医药》2019年第14期31-34,共4页Shandong Medical Journal

基　　金：天津市自然科学基金资助项目(17JCYBJC28000);天津市卫生行业重点攻关项目(13KG105;16KG101);天津医学会麻醉学分会中青年科研培育基金项目(TJMZJJ-2017-01);天津市第一中心医院科研基金项目(CF201819)

摘　　要：目的比较七氟醚与异丙酚复合麻醉对小儿活体肝移植术后急性肾损伤的影响。方法择期全麻下活体肝移植术小儿80例,采用随机数字表法分为两组各40例。两组麻醉诱导药物相同,经口气管插管,机械控制通气;麻醉维持:S组持续吸入七氟醚并维持呼气末浓度2. 5%～3. 0%,P组静脉输注1%异丙酚9～15 mg/(kg·h);两组间断静脉注射芬太尼1～3μg/kg,静脉输注顺苯磺酸阿曲库铵0. 12 mg/(kg·h)维持肌松。分别于切皮即刻(T_1)、无肝期30 min(T_2)、新肝期3 h(T_3)、术后24 h(T_4)和术后3 d(T_5),监测血流动力学指标;采集中心静脉血样,比色法检测血肌酐(Scr)并判断是否发生AKI,酶联免疫吸附法检测血清TNF-α、IL-18、IL-10和中性粒细胞明胶酶相关脂质运载蛋白(NGAL)。结果与P组比较,S组患儿AKI发病率较低,平均动脉压波动较小,血清TNF-α、IL-18和NGAL水平均较低(P均<0. 05),而两组血清IL-10水平差异无统计学意义。结论与异丙酚麻醉相比,七氟醚麻醉下肝移植术患儿肾损伤程度减轻,AKI发生率较低;这可能与七氟醚麻醉可以稳定血流动力学变化、抑制炎症反应有关。Objective To compare the effects of propofol and sevoflurane on acute kidney injury (AKI) in infants undergoing pediatric living donor liver transplantation. Methods Eighty infants undergoing pediatric parent liver transplantation under general anesthesia were randomly divided into two groups,with 40 in each.We used the same anesthetic induction drugs,with oral endotracheal intubatton,and mechanically controlled ventilation.Anesthesia maintenance:in the group sevoflurane (S),the infants continued to inhale sevoflurane and we maintained end-tidal concentration of 2.5% to 3.0%;in the group propofol (P),the infants received 1% propofol intravenously 9-15 mg /(kg·h);the infants in the two groups received intermittent intravenous injection of fentanyl 1-3 μg/kg,intravenous infusion of atracurium cisbesulfate 0.12 mg /(kg · h) to maintain muscle relaxation.Central venous blood samples were collected at the immediate incision (T1),at 30 min of anhepatic phase (T2),at 3 h of neohepatic phase (T3),at 24 h after surgery (T4) and at 3 d after surgery (T5).The hemodynamic indicators were monitored,and the levels of serum creatinine (Scr) was detected by colorimetric method to determine whether or not acute kidney injury (AKI) occurred.The levels of tumor necrosis factor-α(TNF-α),interleukin -18 (IL-18),interleukin -10 (IL-10) and neutrophil gelatinase-associated lipocalin (NGAL) were detected by enzyme-linked immunosorbent assay (ELISA). Results Compared with group P,the incidence of AKI was lower in the group S,the mean arterial pressure fluctuation was smaller,the serum levels of TNF-α,IL-18 and NGAL were lower (all P <0.05),while no statistically significant difference was found in the serum IL-10 between these two groups. Conclusion Compared with propofol anesthesia,the degree of renal injury is reduced in infants undergoing liver transplantation with sevoflurane anesthesia,and the incidence of AKI is lower,which may be related that sevoflurane anesthesia stabilizes hemodynamic changes and inhibits inflammatory res

关 键 词：急性肾损伤 异丙酚 七氟醚 小儿肝移植术 血流动力学 炎症反应 

分 类 号：R614[医药卫生—麻醉学]