- 期刊
Isoflurane對腎功能之影響
Renal Effect of Isoflurane
摘要
Isoflurane是一種ether的衍生物，可代謝成無機氟化物（inorganic fluoride），被認爲可能影響腎功能或造成毒害（nephrotoxicity）。本研究乃以菊糖（inulin）及對位胺基馬尿酸（PAH）清除率方法，測量腎小球濾過率，腎血漿流量和鈉、鉀及水的排泄與血壓變化情形，探討isoflurane麻醉對人體腎功能的影響isoflurane在1MAC的肺泡濃度維持麻醉時，人的心縮壓（systolic blood pressure）略微下降，但心舒壓和平均動腺壓無明顯改變。菊糖清除率（C_(IN)）降低約30％（P ＜0.05）；代表腎血漿流量的C_(PAH)麻醉後2-3小時下降约50％（P ＜0.05），這些腎功能值在停止麻醉後1小時即恢復與麻醉誘導前無差異，鈉的總排泄量（U_(Na)．V）和排泄分率（FE_(Na)）在麻醉時皆同時減少，顯示此時鈉經腎小管再吸收的百分比增加。鉀的總排泄量（U_k．V時）麻醉初1小時未改變，排泄分數卻增加，其後則明顯降低，排泄分率則復原。尿流量在初期未變，但在後期（第2-3小時）顯著減少，纯水的重吸收，在麻醉中也減少。這些結果顯示以isoflurane麻醉雖會降低腎血漿流量，腎小球濾過率及排泄鹽類和水分的功能，但其影響在麻醉停止30-60分鐘內立即原，顯示isoflurane對腎血流動力和排泄功能的影響是暫時且可逆性。
並列摘要
Isoflurane is a penafluorinated methyl ether and can be metabolized to inorganic fluoride in man. Nephrotoxicity may be developed after it's administration. The present study was carried out to evaluate the effects of isoflurane on renal hemodynamic and excretory function in 15 patients. The systolic, diastolic and mean arterial pressure and renal function were measured before, during and after induction of anesthesia by isoflurane. Renal plasma flow (RPF) and glomerular filtration rate (GFR) were estimated by the clearances of paraamino hippuric acid and inulin, respectively. The results showed that a slight reduction in systolic pressure but no significant change in diastolic and mean blood pressures were found during anesthesia. There were 30% and 50% reductions in RPF and GFR, respectively. The filtration fraction increased significantly. Simultaneous decreases in urine flow, absolute and fractional excretions of sodium, absolute excretion of potassium, osmolar clearance and free water reabsorption rate were observed during isoflurane anesthesia. However, the blood pressure and renal function returned to pre-anesthesia levels 30-60 minutes after termination of anesthesia. These data suggest that isoflurane induces renal depressive effect which is reversible and temporary.