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| 吸入麻醉和静脉麻醉对心脏手术患者术后急性肾损伤的影响 |
| Effect of inhalation anesthesia versus intravenous anesthesia on acute kidney injury after cardiac surgery |
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| DOI：10.12089/jca.2022.11.011 |
| 中文关键词: 吸入麻醉 丙泊酚 静脉麻醉 心脏手术 急性肾损伤 |
| 英文关键词: Volatile anesthesia Propofol Intravenous anesthesia Cardiac surgery Acute kidney injury |
| 基金项目:四川省自然科学基金（2022NSFSC1297）；四川大学华西医院博士后基金（2021HXBH079） |
| 作者 | 单位 | E-mail | | 刘红梅 | 610041,成都市,四川大学华西医院麻醉科 | | | 玉红 | 610041,成都市,四川大学华西医院麻醉科 | | | 蒋加丽 | 610041,成都市,四川大学华西医院麻醉科 | | | 李雪霏 | 610041,成都市,四川大学华西医院麻醉科 | | | 余海 | 610041,成都市,四川大学华西医院麻醉科 | yuhaishan117@hotmail.com |
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| 中文摘要: |
目的 探讨吸入麻醉和静脉麻醉对心脏手术患者术后急性肾损伤（AKI）的影响。
方法 选择行择期心肺转流下心脏手术的患者318例，男156例，女162例，年龄18～81岁，BMI 14～35 kg/m2，ASA Ⅱ—Ⅳ级。随机分为两组：吸入麻醉组（I组）和静脉麻醉组（P组），每组159例。记录术后2 d内AKI发生率。记录AKI分级和肾脏替代治疗（RRT）发生情况，机械通气时间，ICU停留时间，术后住院时间，麻醉诱导前、到达ICU时、术后24、48 h血清肌酐（Scr）、尿素氮（BUN）、胱抑素C、估计肾小球滤过率（eGFR），术后1、2、3 d液体输入量、尿量、利尿剂使用量，术后30 d主要肾脏不良事件和术后6个月死亡率。
结果 术后2 d内I组发生AKI 29例（18.2%），P组25例（15.7%），两组差异无统计学意义。I组被诊断为AKI 2级或3级3例（1.9%），其中1例在住院期间接受RRT，P组无一例接受RRT。两组机械通气时间，ICU停留时间，术后住院时间差异无统计学意义。两组不同时点BUN、胱抑素C、eGFR，术后1、2、3 d液体输入量、尿量、利尿剂使用量，术后30 d主要肾脏不良事件和术后6个月内死亡率差异无统计学意义。
结论 在心脏手术中，麻醉维持方式的选择，吸入麻醉或静脉麻醉，不影响患者术后AKI的发生风险。 |
| 英文摘要: |
Ojective To assess the effect of inhalation anesthesia and propofol-based intravenous anesthesia on acute kidney injury (AKI) in patients undergoing cardiac surgery.
Methods A total of 318 patients undergoing cardiac surgery under cardiopulmonary bypass, 156 males and 162 females, aged 18-81 years, BMI 14-35 kg/m2, ASA physical status Ⅱ-Ⅳ, were recruited. Patients were randomly assigned to receive either volatile anesthesia (group I) or propofol-based intravenous anesthesia (group P) during surgery, 159 patients in each group. The incidences of AKI within 2 days postoperatively were recorded. The stage of AKI, the incidence of renal replacement therapy (RRT), mechanical ventilation time, ICU stay and length of hospital stay were recorded. And serum creatine (Scr), urea nitrogen (BUN), cystatin C and estimated glomerular filtration rate (eGFR) were recorded before anesthesia induction, upon arrival in the ICU, and 24 and 48 hours after surgery. In addition, fluid infusion volume, urine output, and diuretics dosages on the 1st, 2nd and 3rd days postoperatively, major renal adverse events within 30 days after surgery and mortality within 6 months after surgery were also recorded.
Results There were 29 cases (18.2%) of AKI in group I and 25 cases (15.7%) in group P within 2 days after operation. There was no significant difference between the two groups. Three patients (1.9%) in group I was diagnosed with AKI grade 2 or 3, of which 1 patient received RRT during hospitalization and none of them received RRT in Group P. There were no significant differences in the mechanical ventilation time, ICU stay and length of hospital stay between the two groups. And there were no significant differences in BUN, cystatin C, eGFR, fluid infusion volume, urine output and diuretic dosages, major renal adverse events within 30 days after surgery and mortality within 6 months after surgery between the two groups.
Conclusion Choosing either volatile anesthesia or propofol-based intravenous anesthesia does not have an impact on the risk of AKI after cardiac surgery. |
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