摘要
传统的非甾体类抗炎药主要通过抑制肾脏环氧化酶活性而产生肾脏副作用，包括减少肾血流、降低肾小球滤过率、减少钠钾排出等。本实验旨在研究静脉注射对乙酰氨基酚或帕瑞昔布对老年骨科手术患者肾脏功能的影响。对75例行髋关节置换或股骨干手术的患者（76±8岁，均数±标准差）进行随机分组、安慰剂对照研究。患者到达麻醉恢复室后立即接受研究药物的首次剂量：对乙酰氨基酚1000mgⅣ（n=25）、帕瑞昔布40mgⅣ（n=25）或生理盐水Ⅳ（n=25）；然后按一定的药物剂量在随后的3天内连续给药。以阿片类药物作为镇痛补救药物。手术前后取血样、啄样并测定肾功能指标。在首剂给予帕瑞昔布后的第1个2小时，肌酐清除率轻度降低（125±83至86±45ml／min，P〈0．05），而安慰剂组和对乙酰氨基酚组的肌酐清除率未见显著下降。所有患者治疗后钠钾排出、尿白蛋白和α1微球蛋白均呈一过性增高（组间差异没有显著性）。总之，在骨科手术后所有患者的肾脏球管功能均受到一过性影响，但各治疗组之间的差异较小且没有临床相关性。尚有待进一步研究以明确长时间使用这些药物对肾脏的副作用，特别是对于伴有肾脏损害或其他合并疾病的患者。
The corrunon adverse effects of traditional nonsteroidal antiinflammatory drugs on renal function include reductions in renal blood flow, glomerular filtration rate, and sodium and potassium excretion, mainly via inhibition of renal cydooxygenase. We designed the present study to determine the effects of Ⅳ paracetamol or parecoxib on renal function in elderly patients undergoing orthopedic surgery. Seventy-five patients （76 ± 8 yr, mean ± SD） undergoing hip replacement or surgery of the femoral shaft completed this randomized and placebo-controlled study. After their arrival in the postanesthesia care unit, patients received an initial dose of the study medication, paracetamol 1000 mg Ⅳ（n = 25）, parecoxib 40 mg Ⅳ （n = 25）, or saline Ⅳ （n = 25）; subsequent doses were administered for the next 3 days. Opioids were provided as rescue medication. Blood and urine samples were collected before and after surgery, and markers of renal function were determined. During the first 2 h after the initial dose of parecoxib, creatinine clearance was slightly diminished （125 ±83 to 86 ±45 ml/min, p 〈 0. 05）, whereas no significant decrease of creatinine clearance was observed in the placebo and paracetamol groups. After all treatments, sodium and potassium excretion as well as urine albumin and α-1-microglobulin were transiently increased （group differences： not signicifant）. In condusion, glomerular and tubular functions were transiently affected in all patients after orthopedic surgery; however, the differences between the treatment groups were small and not clinically relevant. Further studies are warranted to determine adverse renal effects of longer-lasting therapy with these drugs, especially in patients with renal impairment or concomitant diseases.
出处
《麻醉与镇痛》
2008年第2期76-82,共7页
Anesthesia & Analgesia
