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目的 :七氟醚与钠石灰可产生降解反应 ,生成以化合物A为主的 5种降解产物 ,并对肾脏有潜在毒性作用。本文主要观察七氟醚在小流量半紧闭吸入麻醉下肾功能及尿酶学变化。方法 :选择 11例胸腹手术时间较长病例在七氟醚小流量半紧闭吸入麻醉下 ,分别取术前、术中、术后 2 4、48、72小时尿液检测肌酐 (CRE)、尿素氮 (BUN)、γ 谷氨酰胺转肽酶 (GGT)、N 己酰 β D 氨基葡萄糖苷 (NAG)以及 β2 微球蛋白 (β2 MG) ,术中监测钠石灰温度。结果 :11例病人最低肺泡麻醉浓度时间 (MAC h)为 7 4± 1 2 ;麻醉前后CRE、GGT和BUN变化无统计学意义 (P >0 0 5 ) ,NAG和 β2 MG在麻醉后一过性增多 (P <0 0 5 ) ,可能是由于化合物A或其他代谢产物与肾小管蛋白质相结合 ,肾浓缩功能暂时性下降所致 ;钠石灰温度最高为 44 9℃。结论 :七氟醚小流量半紧闭循环吸入麻醉除暂时性影响近端肾小管重吸收外 ,对肾功能无明显影响
OBJECTIVE: Sevoflurane and sodium lime can produce biodegradation reaction and produce five kinds of degradation products mainly composed of compound A, and have potential toxicity to the kidney. This article mainly observed sevoflurane in small flow semi-occlusive inhalation anesthesia changes in renal function and urinary enzymes. Methods: Eleven patients with longer thoracoabdominal surgery were enrolled in the sevoflurane anesthesia with small flow and semi-closed inhalation. Creatinine (CRE) was detected in 24 hours, 48 hours and 72 hours after operation. BUN, GGT, NAG, and β2 microglobulin (β2 MG) were monitored intraoperatively for soda lime temperature. Results: The minimum time of alveolar anesthesia (MACh) in 11 patients was 74 ± 12, the changes of CRE, GGT and BUN before and after anesthesia had no statistical significance (P> 0.05), but NAG and β2 MG had not changed after anesthesia (P <0 05), possibly due to the transient decrease of renal concentration function due to the combination of compound A or other metabolites with tubular proteins; the highest sodium lime temperature was 44 9 ℃. CONCLUSIONS: Sevoflurane, a small flow semi-occlusive inhalation, has no effect on renal function except for transient proximal tubular reabsorption