低流量七氟醚吸入麻醉对新生儿肾功能的影响

Effects of inhalation anesthesia with low-flow sevoflurane on renal function of neonates

目的 评价低流量七氟醚吸入麻醉对新生儿肾功能的影响.方法 择期全麻下行腹部手术新生儿40例,性别不限,ASA分级Ⅰ或Ⅱ级,年龄6-28 d,体重1730 - 2928 g.麻醉诱导后吸入七氟醚低流量（氧流量1 L /min）半紧闭维持麻醉,七氟醚呼气末浓度2.5％ - 4.0％,于麻醉诱导前（T0）、术毕即刻（T1）、术后24、48和72 h（T2-4）时取外周静脉血和尿液,检测血清肌酐（SCr）、尿素氮（BUN）和尿视黄醇结合蛋白（RBP）、β-N-乙酰氨基葡萄糖苷酶（NAG）浓度;并于T1时记录CO2吸收剂钠石灰温度.结果 与T0时比较,T1-4时患儿血清Cr和BUN浓度差异无统计学意义（P＞0.05）,T1时尿RBP浓度升高（P＜0.05）,T2-4时差异无统计学意义（P＞ 0.05）;T2时NAG浓度升高（P＜0.05）,T1,3,4时差异无统计学意义（P＞0.05）.术毕CO2吸收剂钠石灰温度为（37±3）℃.结论 低流量（氧流量1 L/min）七氟醚吸入麻醉对新生儿肾功能无明显影响.

Objective To evaluate the effects of inhalation anesthesia with low-flow sevoflurane on the renal function of neonates.Methods Forty ASA physical status Ⅰ or Ⅱ neonates undergoing abdominal surgery under general anesthesia,aged 6-28 days,weighing 1730-2928 g,were included in the study.After induction of anesthesia,anesthesia was maintained with sevoflurane inhalation using a semi-closed circuit system （FGF 1 L/min）.The end-tidal concentration of sevoflurane was maintained at 2.5%-4.0% according to the vital signs.Before induction of anesthesia,immediately after operation,and at 24,48 and 72 h after operation,blood samples from the peripheral vein and urine specimens were taken for determination of serum concentrations of creatinine （Cr）,blood urea nitrogen （BUN）,urinary retinol binding protein （RBP） and β-N-acetyl-glucosaminidase （NAG）.A temperature probe was inserted to the center of soda lime canister.Results Compared with the baseline value at T0,no significant changes were found in the serum Cr and BUN concentrations at T1-4,urinary RBP concentrations were increased at T1,no significant changes were found in urinary RBP concentrations at T2-4,NAG concentrations were significantly increased at T2 and no significant changes were found in NAG concentrations at T1,3,4.The temperature of soda lime was （37 ± 3） ℃ at the end of operation.Conclusion Inhalation anesthesia with low-flow sevoflurane （FGF 1 L/min） produces no significant effect on the renal function of neonates.