七氟醚预处理对肝癌切除术后肾损伤的影响

Effect of sevoflurane preconditioning on kidney injury in patients undergoing resection for liver cancer

目的评价七氟醚预处理对肝癌切除术患者术后肾损伤的影响。方法纳入60例择期行原发性肝癌切除术的患者,性别不限,年龄38~65岁,体重49~78kg,ASA分级Ⅱ或Ⅲ级,肝功能Child-Pugh分级A级,随机分为七氟醚组(S组)和对照组(C组),每组30例。采用咪达唑仑-顺苯磺酸阿曲库铵-舒芬太尼-异丙酚行麻醉诱导,气管插管后行机械通气,维持PETCO2在35~45mm Hg。麻醉维持:静脉输注异丙酚、瑞芬太尼,间断静脉注射顺苯磺酸阿曲库铵。术中维持BIS值在40~60。S组于气管插管后吸入七氟醚(维持呼气末浓度为2%),持续30min后洗出;C组仅给予纯氧,其他与S组相同。分别于麻醉诱导前、术毕、术后24小时和48小时抽取中心静脉血样,测定血清肌酐、尿素氮、半胱氨酸蛋白酶抑制剂C(Cys-C)的水平。结果两组各时间点血清肌酐和尿素氮水平比较差异均为显著性(P>0.0.5),但S组术后24小时和48小时血清Cys-C水平明显低于C组(P<0.05)。结论七氟醚预处理可有效减轻肝癌切除术后的肾损伤。

Objective To evaluate the effect of sevoflurane preconditioning on kidney injury in patients undergoing resection for liver cancer. Method Sixty diabetic patients of both sexes, aged 38-65yr, weighing49-78kg,of ASA physical status Ⅱ or Ⅲ（1iver function Child-Pugh grade A）, scheduled for elective liver cancer resection, were randomly divided into 2 groups（n=30 each）using a random number table： sevoflurane preconditioning group （S group） and control group（C group）. Anesthesia was induced with midazolam, cisatracurium besilate, sufentanil and propofol. The patients were endotracheally intubated and mechanically ventilated. Anesthesia was maintained with iV infusion of propofol and remifentanil and intermittent iV boluses of cisatracurium besylate. BIS value was maintained at 40-60 during operation. S group inhaled sevoflurane with the end-tidal concentration of 2.0% for 30 rain starting from the end of intubation, followed by washout, while in group C, the patients inhaled only 100%O2. Before induction of anesthesia, at the end of operation, and at 24 and 48 h after operation. blood samples were collected from the central vein for determination of the levels of serum creatinine,blood urea nitrogen, serum cystatin C. Result Compared with group C, the levels of serum cystatin C at 24 and 48 h after operation were significantly decreased, and no significant changes were found in the levels of serum ereatinine and blood urea nitrogen at each time point in group S. Conclusion Sevoflurane preconditioning can reduce kidney injury in the patients undergoing resection for liver cancer.