长时间气腹下不同流量七氟醚对肾功能的影响

Effects of different flow sevoflurane anesthesia on renal functions in long-term pneumoperitoneum

目的观察长时间气腹（〉3h）下高流量和极低流量七氟醚对肾功能的影响。方法择期行腹腔镜腹部手术患者80例，年龄28-65岁，随机均分为两组，机械通气后将新鲜气体流量分别设置为2L／min（H组）和0．5L／min（L组）。气腹时间均超过3h。术中七氟醚呼气末浓度维持在2％左右，气体流量不变。于麻醉前（T0）、气腹2h（T1）、3h（T2）、气腹结束后1h（L）、术后第1天（T4）取血样检测血肌酐（Scr）和尿素氮（BUN）等。结果与T0时比较，T1-T3时L组Scr明显升高（P〈0．05或P〈0．01），T2、T3时L组BUN亦明显升高，且L组Scr、BUN明显高于H组（P〈0．01）。结论长时间气腹状态下，七氟醚流量2L／min对肾功能影响较小，而0．5L／min气体流量可能会有急性肾损伤的危险，应慎用。

Objective To investigate the effects of high-flow and minimal-flow sevoflurane anesthesia on renal functions in long-term pneumoperitoneurn. Methods Eighty ASA I or II patients, aged 28-65 yr, scheduled for laparoscopic operation under general anesthesia （pneumoperitoneurn over 3 h）, were randomly divided into two groups（n= 40 each）： high-flow anesthesia group（group H）and minimal-flow anesthesia group（group L）. The patients were tracheal intubated after anesthesia induction and mechanically ventilated. The fresh gas flow of oxygen was set at 2 L/min in group H and 0. 5 L/min in group L. The end-tidal concentration of sevoflurane was maintained at about 2 % during operation. The oxygen flow rate was kept constant. Venous blood samples were taken at the time before anesthesia（T0 ）, pneumoperitoneum 2h（T1 ）, pneumoperitoneum 3 h（T2）, and 1 h after pneumope ritoneum （T3） and 24 h after surgery （T4） to measure the serum blood urea nitrogen （BUN） and serum creatinire （Scr） levels. Results In group L, Scr levels significantly increased at T1-T3 compared to that at To （P 〈 0. 05 or P 〈 0. 01 ）; BUN levels significantly increased at T2 and T3. Scr and BUN levels were significantly higher in group L at T2 and T3 compared to those in group H at the same time points （P〈0. 01）. Conclusion Sevoflurane anesthesia with a fresh gas flow rate of 2 L/min has little influence on renal function in long-term pneumoperitoneum, whereas a low gas flow rate of 0. 5 L/min may cause acute kidney injury, which should be used cautiously.