地氟烷对活体肝移植患儿术后早期急性肾损伤的影响  

Effect of desflurane on early postoperative acute kidney injury after living donor liver transplantation in children

作　　者：任恒昌[1] 于洪丽[1] 朱敏[1] 翁亦齐[1] 喻文立[1] FREN Hengchang;YU Hongli;ZHU Min(Department of Anesthesiology,Tianjin First Central Hospital,Tianjin 300192,CHINA)

机构地区：[1]天津市第一中心医院麻醉科,300192

出　　处：《江苏医药》2024年第3期228-232,共5页Jiangsu Medical Journal

基　　金：国家自然科学基金(82072219);天津市医学重点学科(专科)建设项目(TJYXZDXK-045A);天津市卫生健康委员会科技项目(ZC20223)。

摘　　要：目的探讨地氟烷对活体肝移植患儿术后早期急性肾损伤(AKI)的影响。方法因胆道闭锁行活体肝移植术的患儿113例,随机分为地氟烷组(D组,58例)和丙泊酚组(P组,55例)。D组患儿术中采用持续吸入地氟烷1.0±0.3 MAC维持镇静,P组患儿术中采用丙泊酚中/长链脂肪乳9~15 mg·kg^(-1)·h^(-1)持续泵入维持镇静。记录相关临床和实验室检测指标。分别于麻醉诱导后(T1)、再灌注后1 h(T2)、术毕(T3)、术后24 h(T4)和术后72 h(T5)检测患儿血清高迁移率族蛋白B1(HMGB1)、IL-6、TNF-α和胱抑素C水平。评估术后3 d AKI的发生和分级,观察术后恢复和预后。结果与P组比较,D组术中低血压和使用多巴胺维持循环的比例减少,T2~T4时血清HMGB1、IL-6、TNF-α和胱抑素C水平降低(P<0.05),T5时血清胱抑素C水平降低(P<0.05),3级AKI发生率和AKI总发生率下降(P<0.05),机械通气时间和ICU停留时间缩短(P<0.05)。结论地氟烷可减轻活体肝移植患儿再灌注后肾损伤,降低术后早期AKI的发生率,缩短术后恢复时间。其机制可能与抑制再灌注后HMGB1释放和炎性因子生成,从而减轻肾炎性损伤相关。Objective To investigate the effect of desflurane on the early postoperative acute kidney injury(AKI)after living donor liver transplantation in children.Methods A total of 113 children with biliary atresia undergoing living donor liver transplantation were divided into two groups.Group D(58 cases)received continuous inhalation of desflurane 1.0±0.3 MAC,and group P(55 cases)received continuous pumping of propofol medium/long chain fat milk 9-15 mg·kg^(-1)·h^(-1)to maintain sedation.The relevant clinical and laboratory data were recorded.Serum levels of high mobility group protein B1(HMGB1),IL-6,TNF-α and cystatin C were detected after anesthesia induction(T1),one hour after reperfusion(T2),after surgery(T3),24 hours after surgery(T4)and 72 hours after surgery(T5).The occurrence and grade of AKI 3 days after surgery were evaluated,and postoperative recovery and prognosis were observed.Results Compared with group P,the incidences of intraoperative hypotension and using dopamine to maintain circulation were lower,serum levels of HMGB1,IL-6,TNF-αand cystatin C at T2-T4 were lower and that of cystatin C at T5 was lower,the incidence of grade 3 AKI and the overall incidence of AKI were decreased,and the mechanical ventilation time and ICU stay time were shorter in group D(P<0.05).ConclusionDesflurane can alleviate the renal injury after reperfusion,reduce the incidence of early postoperative AKI and shorten the postoperative recovery time after living donor liver transplantation in children.The mechanism may be related to inhibiting the release of HMGB1 and the production of inflammatory factors after reperfusion,and alleviating the inflammatory injury of kidney.

关 键 词：地氟烷 肝移植 急性肾损伤 儿童 

分 类 号：R657[医药卫生—外科学]