异丙酚与七氟醚对腹主动脉瘤修复术患者术后肾缺血再灌注损伤影响的比较研究

    A comparative study on effects of propofol and sevoflurane on renal ischemia reperfusion injury after abdominal aortic aneurysm repair

    • 摘要: 目的 比较异丙酚与七氟醚对腹主动脉瘤修复术患者术后肾缺血再灌注损伤的影响。方法 选取2014年12月至2016年6月于陕西省第二人民医院行择期肾下型腹主动脉瘤修复术患者108例为本研究试验对象,随机将其分为A、B两组,每组各54例。A组患者接受丙泊酚麻醉,B组患者接受七氟醚麻醉。记录两组患者在麻醉开始5 min内(T0)、手术末(T1)、手术后8 h (T2)、手术后16 h (T3)及手术后24 h (T4)的肾特异性尿蛋白含量(NGAL、α1-M、GST-pi及GST-α)和血浆促炎细胞因子含量(TNF-α和IL-1β)。记录两组患者于基线期、手术后1 d、3 d和6 d时的血肌酐、胱抑素C水平和24 h尿量。结果 在T1期,A、B组患者的NGAL、α1-M、GST-pi及GST-α含量均达到最高值,随后呈下降趋势。但A组的尿蛋白含量始终显著低于B组,如T1时NGAL含量分别为(1.01±0.38)vs(1.24±0.34) ng/mL (P=0.03)。两组患者的血肌酐和胱抑素-C水平的变化趋势同尿蛋白,即手术后A组患者的血肌酐、胱抑素-C水平和24 h尿量均显著低于B组(P<0.05)。A、B两组患者手术后血浆促炎细胞因子水平随时间显著升高,但即使在不同时间点A组的TNF-α和IL-1β均显著低于B组,如T4期TNF-α水平(213±49)vs(366±40) ng/L (P=0.04)。结论 丙泊酚可显著减低腹主动脉瘤修复术患者术后的肾缺血再灌注损伤程度。

       

      Abstract: Objective To compare the effects of propofol and sevoflurane on renal ischemia reperfusion injury after abdominal aortic aneurysm repair. Methods A total of 108 patients receiving elective infrarenal abdominal aortic aneurysm repair in Second People's Hospital of Shanxi Province from December 2014 to June 2016 were chosen as the subjects in this study, and randomly divided into group A and B with 54 patients in each group. Patients in group A received propofol anesthesia and those in group B received sevoflurane anesthesia. Kidney specific urinary proteins (NGAL, α1-M, GST-pi and GST-α) and plasma inflammatory cytokines (TNF-and IL-1β) were measured within 5 min after starting anesthesia (T0), at the end of surgery(T1), and at 8 h(T2), 16 h(T3) and 24 h(T4) after surgery. Serum creatinine, cystatin C and 24-hour urine output were measured at the baseline and at 1d, 3d and 6d after surgery. Results At T1, the NGAL, α1-M, GST-pi and GST-α level in both groups reached to the highest values, and then tended to reduce. However, the protein level in group A was significantly lower than that in group B, such as NGAL value (1.01±0.38) vs (1.24±0.34) ng/mL at T1, with P=0.03. Changes in serum creatinine, cystatin C and 24-hour urine output were similar to urinary protein, i.e. the levels of serum creatinine, cystatin C and 24-hour urine output after surgery in group A were notably lower than that in group B (P<0.05). The plasma proinflammatory cytokine levels in both groups increased over time, but even at different points the TNF-α and IL-1β in group A were lower than those in group B, such as TNF-α level (213±49) vs (366±40) ng/L at T4, with P=0.04. Conclusions Propofol can significantly reduce the severity of renal ischemia reperfusion injury after abdominal aortic aneurysm repair.

       

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