不同麻醉方法对活体供肾肾移植患者围术期肾功能的影响

目的 探讨选择全静脉全身麻醉(total intravenous anesthesia,TIVA)和腰-硬联合麻醉(combinedspinal-epidural anesthesia,CSEA)不同的麻醉方法对接受亲属活体供肾移植手术患者围术期肾功能的影响是否存在差异.方法 选择择期行亲属活体供肾移植手术的患者60例,均为首次接受肾移植术患者.供受者均为血缘亲属关系,供肾者全部选择在全静脉全身麻醉下经开放术式取肾,供肾热缺血时间50秒～90秒,冷缺血时间60 min～120 min.随机将60例患者分为2组(TIVA组和CSEA组),每组30例,TIVA组术后给予经静脉术后镇痛(patient-controlled intravenous analgesia,PCIA)2d;CSEA组术后给予经硬膜外术后镇痛(patient-controlled epidural analgesia,PCEA)2d.分别记录肾移植手术时间;移植肾开放时平均动脉压(MAP)和心率(HR);移植肾开放后第1、2、3、5、7天的尿量;血肌酐(Cr);血尿素氮(BUN)以及内生肌酐清除率(Ccr)的变化;术后随访患者镇痛满意度.结果 TIVA组手术时间为(171±29)min,CSEA组手术时间为(173±29)min,两组比较无统计学差异(P＞0.05);移植肾血管吻合口开放时TIVA组MAP为(149±10)mm Hg,CSEA组MAP为(139±12)mm Hg,两组比较为差异有统计学意义(P＜0.05);两组移植肾血管吻合口开放时HR组间比较差异无统计学意义(P＞0.05);两组移植肾开放后第1、2、3、5、7天尿量、Cr、BUN和Ccr组间比较差异均无统计学意义(P＞0.05).结论 全静脉全身麻醉与腰-硬联合麻醉对接受亲属活体供肾移植手术患者围术期肾功能的影响无统计学差异,两种麻醉方法都可以安全用于肾移植手术患者.

Effects of different anesthesia methods on renal function of the living kidney receiptors after transplantation

Objective To compare the effect of total intravenous anesthesia(TIVA) and combined spinal-epidural anesthesia (CSEA) on renal function of the living kidney receiptors after transplantation. Methods 60 adult patients undergoing living kidney transplantation were randomly divided into two groups(n=30). The receiptors were anesthetized using TIVA method (group TIVA) or CSEA method(group CSEA) followed with PICA and PECA, respectively for 2 postoperative days. Results MAP( 149±10) mm Hg, but not HR, in group TIVA was higher than that that in group CSEA (139±12) mm Hg at the moment of kidney reperfusions. There were no significant difference in urine volume, plasma Cr, BUN, Ccr levels between two groups. Conclusion There are no significant differences in renal function between TIVA and CSEA methods for living kidney receiptors.