胃癌根治手术对老年病人围术期肾功能的影响

Effect of renal function in the elderly during gastric carcinoma undergoing surgery

目的观察胃癌根治手术对老年病人围术期肾功能的影响。方法全身麻醉下择期行胃癌根治手术的病人40例分为两组,每组20例:老年组(Ⅰ组)年龄≥65岁,中年组(Ⅱ组)年龄<65岁,分别于麻醉诱导前(T0)、手术开始后1h(T1)、术后第1天(T2)、第3天(T3)和第5天(T4)留取血、尿标本,测定血肌苷(Cr)、尿素氮(BUN)和尿中Cr、βN乙酰(基)D氨基葡萄糖苷酶(NAG)、α1微球蛋白(α1MG)、微量白蛋白(Alb)的含量。结果两组各时点血Cr和BUN均在正常范围内。两组尿NAG/Cr和α1MG/CrT1～T4时明显高于T0时(P<0.01)。Ⅰ组尿NAG/CrT0、T4时明显高于Ⅱ组(P<0.05)。两组尿Alb/CrT1、T2时显著增加(P<0.01),且Ⅰ组明显高于Ⅱ组(P<0.05),Ⅰ组T4时恢复至术前值,而Ⅱ组T3时恢复至术前值。结论胃癌根治手术围术期老年病人肾功能损伤较中年人明显。

Objective To investigate the effect of renal function in the elderly during gastric carcinoma undergoing surgery. Methods Forty patients with gastric carcinoma undergoing surgery under general anesthesia were devided into two groups with 20 cases each. The patients aged ≥65y in group Ⅰ were assigned and those〈65y in group Ⅱ. Serum creatinine （Cr）, blood urea nitrogen （BUN）, urinary β-N-Acetyl-D-glucosaminidase （NAG）, α1- microglobulin （α1-MG） and albumin （Alb） were measured before anesthesia induction （To）, 1 h after incision （T1）, on the first （T2）, third （T3） and fifth postoperative day （T4）. Results Serum concentrations of Cr and BUN were in normal range during the observation, but urinary NAG/Cr and α1-MG/Cr increased significantly from T1 to T4 in both groups. NAG/Cr in group Ⅰ was significantly higher than that in group Ⅱ （P〈0.05） at To and T4, while there was no significant difference in α1-MG/Cr between two groups. Alb/ Cr rose significantly at T1 and T2 （P〈0.01） in two groups,which was higher in group Ⅰ than that in group Ⅱ （P〈0.05） and recovered at T4 in group Ⅰ at T3 in group Ⅱ. Conclusion More obvious renal function injury exists in the elderly than that in the middle age during gastric carcinoma undergoing surgery.