不同麻醉方法对活体肝移植小儿肾功能的影响研究

doi:10.3969/j.issn.1672-5069.2022.03.032

摘要/Abstract

摘要： 目的研究不同麻醉方法对接受活体肝移植术小儿肾功能的影响。方法 2017年3月～2020年3月在我院接受活体肝移植患儿54例,其中20例接受七氟醚复合麻醉(A组)、18例接受异氟醚复合麻醉(B组),16例接受丙泊酚复合麻醉(C组)。记录术前1 d(T₁)、术后1 d(T₂)、术后3 d(T₃)和术后5 d(T₄)时血清乳酸脱氢酶(LDH)、血肌酐(sCr)、血尿素氮(BUN)和超声检测计算的肾动脉阻力指数(RI)水平及平均动脉压(MAP)、中心静脉压(CVP)和心率(HR)。结果在T₂、T₃和T₄时,A组血清LDH水平分别为(502.7±114.4)IU/L、(392.8±128.4)IU/L和(340.6±94.3)IU/L,显著低于B组【分别为(582.0±104.8)IU/L、(511.7±94.5)IU/L和(450.6±80.6)IU/L,P<0.05】或C组【分别为(579.6±106.7)IU/L、(498.9±95.2)IU/L和(443.6±82.1)IU/L,P<0.05】;sCr分别为(60.8±13.2)μmol/L、(45.4±9.7)μmol/L和(33.2±8.5)μmol/L,显著低于B组【分别为(71.6±12.8)μmol/L、(58.4±10.3)μmol/L和(49.5±8.9)μmol/L,P<0.05】或C组【分别为(69.3±10.0)μmol/L、(62.2±9.7)μmol/L和(50.3±8.6)μmol/L,P<0.05】;A组MAP分别为(49.3±3.7)mm/Hg、52.9±4.9)mm/Hg和(55.3±4.6)mm/Hg,显著高于B组【分别为(45.9±4.3)mm/Hg、(47.7±3.9)mm/Hg和(51.9±4.5)mmHg,P<0.05】或C组【分别为(44.9±4.4)mm/Hg、(49.2±4.6)mmHg和(51.8±5.0)mm/Hg,P<0.05】,CVP分别为(6.9±1.4)mm/Hg、(7.8±2.0)mm/Hg和(8.4±1.5)mm/Hg,显著高于B组【分别为(5.8±1.5)mm/Hg、(6.4±1.7)mm/Hg和(7.4±1.3)mm/Hg,P<0.05】或C组【分别为(5.6±1.3)mm/Hg、(6.5±1.2)mm/Hg和7.4±0.9)mm/Hg,P<0.05】。结论对于接受活体肝移植患儿,应用七氟醚麻醉有助于保护肾功能,可能与其对血流动力学的影响较小有关。

关键词: 肝移植, 麻醉, 七氟醚, 肾功能, 血流动力学, 小儿

Abstract: Objective The aim of this study was to investigate the impact of combined sevoflurane anesthesia on renal functions in pediatric living donor liver transplantation (LDLT). Methods 54 children with end stage liver diseases (including congenital biliary atresia in 31 cases, hepatolenticular degeneration in 10 cases, hepatic glycogen storage disease in 8 cases and liver failure in 5 cases ) were recruited in our hospital between March 2017 and March 2020, and all received LDLT. The anesthesia included combined sevoflurane in 20 cases (groupA), combined isoflurane in 18 cases (group B) and combined propofol anesthesia in 16 cases (group C). Serum lactate dehydrogenase (LDH), serum creatinine (sCr), and urea nitrogen (BUN) and renal artery resistance index (RI)determined by ultrasonography were obtained. A 1 day before operation (T₁), 1 day after operation (T₂), 3 days after operation (T₃) and 5 days afteroperation (T₄), the mean arterial pressure (MAP), central venous pressure (CVP) and heart rate (HR) were recorded. Results At T₂, T₃ and T₄, serum LDH level in group A were (502.7±114.4)IU/L, (392.8±128.4)IU/L and (340.6±94.3)IU/L, all significantly lower than [(582.0±104.8)IU/L, (511.7±94.5)IU/L and (450.6±80.6)IU/L, respectively, P<0.05] in group B or [(579.6±106.7)IU/L, (498.9±95.2)IU/L and (443.6±82.1)IU/L, respectively, P<0.05] in group C; sCr were (60.8±13.2)μmol/L,(45.4±9.7)μmol/L and (33.2±8.5)μmol/L, all significantly lower than [(71.6±12.8)μmol/L, (58.4±10.3)μmol/L and (49.5±8.9)μmol/L, respectively, P<0.05] in group B or [(69.3±10.0)μmol/L,(62.2±9.7)μmol/L and (50.3±8.6)μmol/L, respectively, P<0.05] in group C; the MAP were (49.3±3.7)mm/Hg, 52.9±4.9)mm/Hg and (55.3±4.6)mm/Hg, all significantly higher than [(45.9±4.3)mm/Hg, (47.7±3.9)mm/Hg and (51.9±4.5)mmHg, respectively, P<0.05] in group B or [(44.9±4.4)mm/Hg,(49.2±4.6)mmHg and (51.8±5.0)mm/Hg, respectively, P<0.05] in group C, the CVP were (6.9±1.4)mm/Hg,(7.8±2.0)mm/Hg and (8.4±1.5)mm/Hg,all significantly higher than [(5.8±1.5)mm/Hg, (6.4±1.7)mm/Hg and (7.4±1.3)mm/Hg, respectively,P<0.05] in group B or [(5.6±1.3)mm/Hg, (6.5±1.2)mm/Hg and 7.4±0.9)mm/Hg, respectively, P<0.05] in group C. Conclusion The combined sevoflurane anesthesia could protect renal functions in children receiving LDLT, which might be related to the less impact on hemodynamics.

Key words: Living donor liver transplantation, Anesthesia, Sevoflurane, Renal functions, Hemodynamics, Children

何志刚, 余洲, 周琳. 不同麻醉方法对活体肝移植小儿肾功能的影响研究[J]. 实用肝脏病杂志, 2022, 25(3): 431-434.

He Zhigang, Yu Zhou, Zhou Lin. Impact of combined sevoflurane anesthesia on renal functions in pediatric living donor liver transplantation[J]. Journal of Practical Hepatology, 2022, 25(3): 431-434.

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