不同程度控制性降压对全髋关节置换老年患者肾功能的影响

EFFECTS OF DIFFERENT HYPOTENSION LEVELS ON RENAL FUNCTION AFTER TOTAL HIP REPLACEMENT IN GERIATRIC PATIENTS

目的探讨控制性降压对老年患者围手术期肾功能的影响。方法选择期手术老年患者(≥65岁)60例,随机分为3组,F_0组(对照组),控制性降压F_1组(基础值20%)和控制性降压F_2组(基础值30%),控制性降压采用泵入硝酸甘油控制性降压;分别于降压前即刻(T_0),降压停止即刻(T_1),术后24h(T_2),测定血中尿素氮、肌酐、α_1-微球蛋白(α_1-microglobulin,α_1-MG)和尿中α_1-MG,并评估术野出血。结果与T_0比较,F_2组在T_1血α_1-MG水平升高(P<0.05);与F_0组比较,控制性降压组术野评分降低(P<0.05)。结论老年围手术期患者硝酸甘油控制性降压在基础值降低20%程度是安全可行的,可以满足手术需要。

Objective To investigate the in geriatric perioperative patients. Methods to three groups： controlled hypotension F1 （ control group）. The mean artery pressure effects of different hypotension levels on renal function Sixty geriatric perioperative patients were randomly assigned group, controlled hypotension F2 group and group F0 group （MAP） in F1 group was decreased 20% and that in F2 group 30% by nitroglycerin infusion. Blood and urine samples were taken beginning（ T0 ） and end （T1 ）, 24h after surgery（ T2 ） for determination of α1-microglobulin（ α1-MG） levels in blood and in urine, blood urea nitrogen and creatinine. The operative field scores were assessed and recorded in the operation. Results The serum α1-MG level was higher at T1 compared to at TO in F2 group （P 〈 0.05 ）, operative field scores were lower in controlled hypotension than in control group （ P 〈 0.05 ）. Condusion MAP decrease 20% is safe and feasible in geriatric perioperative patients.