国际麻醉学与复苏杂志   2015, Issue (9): 9-9
    
丙泊酚在体外循环手术中的肾脏保护作用
邓艳娜, 龙宏杰1()
1.惠州市第三人民医院
Protection role of propofol on renal function in extracorporeal circulation operation
 全文:
摘要:

目的 探讨丙泊酚在体外循环(extracorporeal circulation, ECC)手术中的肾脏保护作用。 方法 选取2008年1月~2014年1月期间于我院进行心脏瓣膜ECC手术治疗的患者124例,按随机数字表法分为观察组和对照组,每组62例。观察组术中采用丙泊酚联合舒芬太尼进行麻醉,对照组术中采用七氟醚联合舒芬太尼进行麻醉。统计分析两组麻醉效果、炎症因子水平、急性肾损伤发生率、24 h尿量及尿中和血浆中B2微球蛋白水平。 结果 观察组麻醉效果为Ⅰ级、Ⅱ级和Ⅲ级的比例分别为56.48%、41.94%和1.61%,对照组Ⅰ级、Ⅱ级和Ⅲ级的比例分别为54.84%、43.55%和1.61%,两组麻醉效果比较,差异无统计学意义(P>0.05)。两组术前、术后即刻和术后1周C反应蛋白(C-reactive protein, CRP)、白细胞介素(interleukin, IL)-6和肿瘤坏死因子(tumor necrosis factor, TNF)-α等炎症因子水平比较,差异无统计学意义(P>0.05),观察组治疗1周的CRP、IL-6和TNF-α分别为(8.5±1.3) mg/L、(16.1±1.2) pg/L和(141±10) pg/L,均低于治疗前的(18.5±3.6) mg/L、(35.1±2.6) pg/L和(316±14) pg/L,对照组术后1周各炎症因子水平均较治疗前降低,差异有统计学意义(P<0.05)。观察组急性肾损伤的发生率为3.23%,显著低于对照组的11.29%,差异有统计学意义(P<0.01)。观察组与对照组术前24 h尿量增加,尿中和血浆中B2微球蛋白水平比较,差异无统计学意义(P>0.05)。与对照组比较,观察组术后即刻和术后1周24 h尿量增加,尿中和血浆中B2微球蛋白水平则降低,差异有统计学意义(P<0.05)。 结论 丙泊酚在ECC手术中麻醉效果好,不会对炎症因子水平造成明显影响且对肾脏的保护作用良好。

关键词: 丙泊酚; 体外循环手术; 肾脏保护
Abstract:

Objective To investigate the protection role of propofol on renal function in extracorporeal circulation(ECC) operation. Methods One hundred and twenty-four patients treated with heart valve ECC operation in our hospital from January, 2008 to January, 2014, were randomly divided into observation group and control group by digital randomized method(n=62). Intraoperative anesthesia of observation group was maintaoned with propofol and sufentanil, while sevoflurane combined with sufentanil was used in controlled group. Anesthesia effect, inflammatory factors and the acute renal injury incidence, 24 h urine volume and urine and plasma microglobulin level of two groups were statistically analyzed. Results Patients′ distribution of anesthetic effect as Ⅰ, Ⅱ and Ⅲ level of observation group were 56.48%, 41.94% and 1.61% respectively, while the data were 54.84%, 43.55% and 1.61% correspondingly in the controlled group, the differences of anesthesia effect between the two groups had no statistical significance(P>0.05). C?蛳reactive protein(CRP), interleukin(IL)?蛳6,tumor necrosis factor(TNF)?蛳α and other inflammatory factors level of two groups preoperative and postoperative immediate and postoperative 1 week had no statistical significance(P>0.05). CRP, IL-6 and TNF-α and other inflammatory factors of observation group after treated for 1 week were(8.5±1.3) mg/L,(16.1±1.2) pg/L and(141±10) pg/L respectively, which were lower than those before treatment [(18.5±3.6) mg/L, (35.1±2.6) pg/L and(316±14) pg/L correspondingly]. Inflammatory factors of the control groups postoperative 1 week was also reduced comparing with those of preoperative, and the differences were statistically significant(P<0.05). Acute kidney injury incidence in observation group was 3.23%, which was significantly less than that of the control group(11.29%), and the difference was statistically significant (P<0.01). Observation group and control group before 24 h urine volume increased, urine and plasma level of β2 microglobulin compared differences no statistical significance(P>0.05). Compared with the control group, 24 h urine volume of observation group postoperative immediate and postoperative 1 week was increased while urine and plasma microglobulin level of observation group postoperative immediate and postoperative 1 week was lowered, and the difference was statistically significant(P<0.05). Conclusions Administration of propofol in ECC operation is worthy of clinical practice for its good anesthesia effect and renal protective effec, and had no obvious effects on the inflammatory factor levels.

Key words: Propofol; Extracorporeal circulation operation; Renal protection