The effect of anaesthesia on renal function.
The effect of anaesthesia on renal function.
复制标题
麻醉对肾功能的影响。
DOI：
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发表时间：
1994
影响因子：
3.6
通讯作者：
G. Kaczmarczyk
中科院分区：
文献类型：
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作者：
Hilmar Burchardi;G. Kaczmarczyk
麻醉和手术应激可间接或直接影响肾功能和体液调节。间接效应通过对血流动力学、交感神经活动和体液调节的影响比直接效应更为明显。吸入麻醉剂通常会降低肾小球滤过率和尿量，主要是通过肾外效应，而术前水合作用会减弱这些效应。阿片类药物、巴比妥酸盐和苯二氮卓类药物也会降低肾小球滤过率和尿量。局部麻醉的效果似乎比全身麻醉要小，而且与全身血流动力学的变化有关。这些围手术期肾功能改变通常是暂时的，临床意义不大。机械通气减少尿量和钠排出的程度取决于胸腔内压力的增加，尽管ADH的释放、压力感受器的卸载和肾素-血管紧张素系统的激活也可能参与其中。麻醉的直接作用是剂量和药物依赖的，包括对肾血流的自动调节的影响，对ADH作用的改变，以及对钠和有机酸的肾小管转运的影响。任何麻醉剂唯一被证实的直接毒性作用是甲氧基氟烷的氟化物相关毒性。
Anaesthesia and surgical stress can affect renal function and body fluid regulation indirectly as well as directly. The indirect effects, through influences on haemodynamics, sympathetic activity and humoral regulation, are more pronounced than the direct ones. Inhalational anaesthetics generally reduce glomerular filtration rate and urine output, mainly by extra-renal effects that are attenuated by pre-operative hydration. Opioids, barbiturates and benzodiazepines also reduce glomerular filtration rate and urine output. The effects of regional anaesthesia seem to be less than those of general anaesthesia and are related to changes in systemic haemodynamics. These peri-operative alterations of renal function are usually transient and clinically insignificant. Mechanical ventilation decreases urine volume and sodium excretion to an extent that depends on the increase in intrathoracic pressure, though ADH release, unloading of baroreceptors and activation of the renin-angiotensin system may also be involved. The direct effects of anaesthesia which are dose- and agent-dependent include effects on autoregulation of renal blood flow, alteration in the effect of ADH, and effects on tubular transport of sodium and organic acids. The only proven direct toxic effect of any anaesthetic agent is the fluoride-related toxicity of methoxyflurane.