吸烟对异氟醚吸入麻醉时无机氟代谢的影响

Influence of Anesthesia with Isofeurane on The Metabolism of Inorganic Fluoride in Smoker Patients

目的:无机氟通过异氟醚代谢而释放,血浆氟离子浓度提高可能损害肾功能。吸烟者可能诱导或者抑制药物代谢,本文研究吸烟和药物代谢之间的相互关系以及可能的毒性。方法:17例非吸烟病人和17例吸烟病人择期行手术,ASA分级为Ⅰ-Ⅱ级,在空气和氧气混合的情况下,给与标准的吸入麻醉药异氟醚1MAC*h,测量血浆无机氟离子24h和肾功能标记物β2-微球蛋白,肿瘤相关胰蛋白酶抑制因子(TATI)和血肌酐48h。结果:非吸烟病人最大的氟离子浓度7.2-23.0(12.8±4.0μmol/L),吸烟病人最大的氟离子浓度7.6-39.0(16.8±6.7μmol/L),平均差值为4.0μmol/L(p<0.05),血β2-微球蛋白,肿瘤相关胰蛋白酶抑制因子(TATI)和肌酐没有提高。血无机氟离子浓度在1MAC*h异氟醚吸入1、2、3和6h。两组之间比较有显著差异(P<0.05),吸入麻醉24h两组病人元机氟离子浓度仍然高于基础水平。48h观察过程中,尿β2-微球蛋白,肿瘤相关胰蛋白酶抑制因子和肌酐比值始终处于低水平。结论:吸烟患者在异氟醚吸入麻醉之后与血浆无机氟离子浓度增高有关系,但是并没有肾功能损害的现象。

Objective: Inorganic fluoride is released by the metabolism of isoflurane and the increased serum fluoride concentrations may impair renal function. Smoker patients that can either induce or inhibit drug metabolism. Studies on the interaction of smoker with anaesthetic drug metabolism and possible toxicity are warranted. Methods: Seventeen smoker patients and 17non-smoker patients generally healthy patients undergoing elective surgery were given 1MAC (minimum alveolar concentration)-hour standardized anaesthesia with isoflurane in oxygen-air mixture. The serum inorganic fluoride and renal function markers β2-microglobulin, tumour-associated trypsin inhibitor(TATI) and serum creatinine were measured for 48h. Results:The greatest inorganic fluoride concentration was between 7. 2 and 23. 0 (mean 12. 8 ± 4. 0))μmol/L in the non-smokers and between 7. 6 and 39. 0(16. 8 ± 6. 7)μ mol/L in the smoker; the mean difference was 4. 0 μmol/L(P<0. 05). Serum β2-microglobulin,TATI and creatinine were not increased. Serum inorganic fluoride concentrations were significantly greater in the smokers compared with the non-smokers 1,2,3 and 6h after 1 MAC-hour inhalation with isoflurane (P<0. 05). Inorganic fluoride concentrations were still increased 24h after anaesthesia in both groups. Urine β2-microglobulin and TATI creatinine ratio remained at low values during the whole 48h period in both groups. Conclusion: Regular smoking is associated with an increase in serum inorganic fluoride concentration after anaesthesia with isoflurane,but there are no signs of renal damage.