全麻下泌尿外科后腹腔镜手术对患者尿NAG、血β_2-微球蛋白的影响

The changes of urinary NAG and serum β_2-MG during the retroperitoneal laparoscopic surgery under general anesthesia in urology

目的探讨全麻下泌尿外科后腹腔镜手术对尿N-乙酰-β-D-氨基葡萄糖苷酶(NAG)、血β2-微球蛋白(β2-MG)的影响。方法 33例气管内插管全身麻醉下行后腹腔镜非肾切除手术患者,对术前和术后0h、24h、48h及72h的血β2-MG、尿NAG指标进行检测,应用统计学方法分析指标动态变化规律,并且比较不同气腹时间与术后各指标变化情况。结果与手术前相比,术后24～48h血β2-MG、尿NAG均有不同程度的增高,术后24～48h达到最高值;术后72h其水平下降明显降低,术前后变化差异具有显著性意义;比较不同气腹时间与各指标变化发现,气腹时间大于60min对血β2-MG、尿NAG、尿肌酐(Cr)影响较明显。结论全麻下实施泌尿外科保留肾脏后腹腔镜手术,可导致患者术后早期血β2-MG、尿NAG水平增高,但这种改变是可逆的,提示泌尿外科后腹腔镜手术可能对肾小球滤过功能及肾小管重吸收功能有一定影响。

Objective To study the effects of artificial carbon dioxide（CO2） pneumoperitoneum on serum β2-MG and urinary NAG during retroperitoneal laparoscopic surgery under general anesthesia.Methods 33 patients undergone selective retroperitoneal laparoscopic surgery which nephrectomy was excluded received general anesthesia with endotracheal intubation.The serum β2-MG and urinary NAG on the day before operation and at the 0 h,24 h,48 h and 72 h after operation,were measured and statistically analyzed.At the same time,it were compared that the different time of CO2 pneumoperitoneum effected on these factors.Results As compared with preoperative measures,levels of serum β2-MG and urinary NAG were increased at various degrees at the 24 h and 48 h after operation,and recovered at the 72 h after operation,significant difference of these parameters in changes during the perioperative period.The levels of serum β2-MG and urinary NAG/Cr were obviously increased when the time of CO2 pneumoperitoneum was over 60 mins.Conclusions The serum β2-MG and urinary NAG/Cr is influenced by CO2 pneumoperitoneum during retroperitoneoscopy but it will be recovery after the 72 h of operation.It maybe indicate that the CO2 pneumoperitoneum probably affects the renal functions.