全麻药与肾切除术后肾功能的关系
本公众号每天分享一篇最新一期Anesthesia & Analgesia等SCI杂志的摘要翻译，敬请关注并提出宝贵意见
General Anesthetic Agents and Renal Function after Nephrectomy
背景与目的
全麻药的选择与肾切除术后急性肾损伤（AKI）和长期肾功能不全的风险之间的关系尚未得到评估。
方 法
我们回顾了1087例部分或根治性肾切除术。比较各全麻药组（异丙酚、七氟醚、地氟醚）术后AKI、新发慢性肾脏病（CKD）的发生率和CKD分期，进行四种不同的倾向性评分分析，以减少每队组合间比较的差异（异丙酚与七氟醚；异丙酚与地氟醚；七氟醚与地氟醚；异丙酚与挥发性药物）。进行kaplan-meier生存曲线分析，比较肾切除术后36个月各组间由新发CKD的最终肾存活率。
结 果
丙泊酚组AKI的发生率较低（丙泊酚23.2%对七氟醚39.5%,P=0.004；丙泊酚21.0%对地氟醚34.3%，=0.031），CKD的发生率较低（丙泊酚27.2%对七氟醚58.4%，<0.001；丙泊酚32.4%对地氟醚48.6%，=0.017），肾切除术后3年肾存活率较低。与七氟醚相比，异丙酚在肾切除术后新发CKD的发生率也较低（P＜0.001）。七氟醚与地氟醚无显著性差异。然而，部分肾切除术的亚组分析显示，只有在CKD的发生上有显著差异。
结 论
异丙酚与挥发性药物相比，可作为一种较好的全身麻醉药物用于肾切除术后减轻肾功能不全。然而，回顾性研究设计的局限性和亚组分析的不一致结果排除了结论的确定性。
原始文献摘要
Lee Ho-Jin,Bae Jinyoung,Kwon Yongsuk et al. General Anesthetic Agents and Renal Function after Nephrectomy.[J] .J Clin Med, 2019, 8
The association between the choice of general anesthetic agents and the risk of acute kidney injury (AKI) and long-term renal dysfunction after nephrectomy has not yet been evaluated. We reviewed 1087 cases of partial or radical nephrectomy. The incidence of postoperative AKI, new-onset chronic kidney disease (CKD) and CKD upstaging were compared between general anesthetic agent groups (propofol, sevoflurane, and desflurane). Four different propensity score analyses were performed to minimize confounding for each pair of comparison (propofol vs. sevoflurane; propofol vs. desflurane; sevoflurane vs. desflurane; propofol vs. volatile agents). Study outcomes were compared before and after matching. Kaplan-Meier survival curve analysis was performed to compare renal survival determined by the development of new-onset CKD between groups up to 36 months after nephrectomy. Propofol was associated with a lower incidence of AKI (propofol 23.2% vs. sevoflurane 39.5%, = 0.004; vs. propofol 21.0% vs. desflurane 34.3%, = 0.031), a lower incidence of CKD upstaging (propofol 27.2% vs. sevoflurane 58.4%, < 0.001; propofol 32.4% vs. desflurane 48.6%, = 0.017) and better three-year renal survival after nephrectomy compared to sevoflurane or desflurane group (Log-rank test propofol vs. sevoflurane < 0.001; vs. desflurane = 0.015) after matching. Propofol was also associated with a lower incidence of new-onset CKD after nephrectomy compared to sevoflurane after matching ( < 0.001). There were no significant differences between sevoflurane and desflurane. However, subgroup analysis of partial nephrectomy showed a significant difference only in CKD upstaging. In conclusion, propofol, compared to volatile agents, could be a better general anesthetic agent for nephrectomy to attenuate postoperative renal dysfunction. However, limitations of the retrospective study design and inconsistent results of the subgroup analysis preclude firm conclusions.
麻醉学文献进展分享
贵州医科大学高鸿教授课题组
翻译：符校魁 编辑：何幼芹 审校：王贵龙