麻醉因素对亲体肝移植术患儿肾损伤的影响:七氟醚复合麻醉与丙泊酚复合麻醉的比较

Effect of anesthesia factor on kidney injury in pediatric patients undergoing living donor liver transplantation:a comparison of sevoflurane-versus propofol-based anesthesia

目的比较七氟醚复合麻醉与丙泊酚复合麻醉对亲体肝移植术患儿肾损伤的影响.方法择期行亲体肝移植术的患儿80例,性别不限,年龄5~15个月,体重5.5~10.0kg,ASA分级Ⅱ或Ⅲ级,采用随机数字表法分为2组(n=40):七氟醚复合麻醉组(S组)和丙泊酚复合麻醉组(P组).S组吸入七氟醚,维持呼气末浓度1.0%~3.0%,P组静脉输注丙泊酚9~15mg·kg^-1·h^-1,2组间断静脉注射芬太尼1~3μg∕kg,静脉输注顺苯磺酸阿曲库铵1~2μg·kg^-1·min^-1.维持BIS值40~60.于切皮即刻(T1)、无肝期30min(T2)、新肝期3h(T3)、术后24h(T4)和术后3d(T5)时采集中心静脉血样和尿样,采用ELISA法检测血清和尿中性粒细胞明胶酶相关脂质运载蛋白(NGAL)及胱抑素C(CysC)水平.记录术中尿量和多巴胺使用情况、低血压和心肌缺血的发生情况.结果与P组比较,S组T3-5时血清和尿NGAL及CysC水平降低(P<0.05),术中尿量、低血压和心肌缺血发生率和多巴胺使用率比较差异无统计学意义(P>0.05).结论与丙泊酚复合麻醉相比,七氟醚复合麻醉下亲体肝移植术患儿肾损伤程度减轻.

Objective To compare the effects of sevoflurane-and propofol-based anesthesia on kidney injury in pediatric patients undergoing living donor liver transplantation.Methods Eighty pediatric patients of both sexes,aged 5-15 months,weighing 5.5-10.0 kg,of American Society of Anesthesiologists physical statusⅡorⅢ,scheduled for elective living donor liver transplantation,were divided into 2 groups(n=40 each)using a random number table method:sevoflurane-based anesthesia group(group S)and propofol-based anesthesia(group P).Sevoflurane was inhaled,and the end-tidal concentration was maintained at 1.0%-3.0%in group S.Propofol 9-15 mg·k^g-1·h^-1 was intravenously infused in group P.Fentanyl 1-3μg/kg was intermittently injected,and cisatracurium 1-2μg·kg^-1·min^-1 was intravenously infused in two groups.Bispectral index value was maintained at 40-60.Immediately before skin incision(T1),at 30 min of anhepatic phase(T2),at 3 h of neohepatic phase(T3),at 24 h after operation(T4)and at day 3 after surgery(T5),blood samples from the central vein and urine specimens were collected for determination of the levels of neutrophil gelatinase-associated lipocalin and cystatin C in serum and urine by enzyme-linked immunosorbent assay.The urine volume,requirement for dopamine and occurrence of hypotension and myocardial ischemia were recorded during surgery.Results Compared with group P,the levels of neutrophil gelatinase-associated lipocalin and cystatin in serum and urine were significantly decreased at T3-5(P<0.05),and no significant change was found in the intraoperative urine volume,incidence of hypotension and myocardial ischemia,or requirement for dopamine in group S(P>0.05).Conclusion Compared with propofol-based anesthesia,kidney injury is attenuated in pediatric patients undergoing living donor liver transplantation under sevoflurane-based anesthesia.