氯诺昔康静脉持续输注镇痛对尿α_1微球蛋白的影响

目的:通过检测尿α1微球蛋白(α1-MG)浓度的变化,探讨氯诺昔康静脉持续输注用于镇痛治疗时的肾脏安全性。方法:75例择期骨科手术病人随机分为3组。芬太尼组26例,单用芬太尼1.2 mg,负荷剂量为静脉注射(静注)芬太尼0.05 mg;氯诺昔康组23例,单用氯诺昔康72 mg,负荷剂量为静注氯诺昔康8 mg;合用组26例,联合应用氯诺昔康36 mg+芬太尼0.9 mg,负荷剂量为静注氯诺昔康4 mg及芬太尼0.025 mg。均用氯化钠注射液稀释至144 mL,静脉持续输注,2 mL.h-1。结果:术后d 4,芬太尼组尿α1-MG上升了(4±s11)mg.L-1(P>0.05),氯诺昔康组和合用组上升了(22±16),(20±16)mg.L-1(P<0.01),上升幅度明显大于芬太尼组(P<0.01),氯诺昔康组和合用组之间差异无显著意义(P>0.05)。手术前后3组尿素氮、肌酐和尿酸比较均无显著差异(P>0.05)。结论:氯诺昔康静脉持续输注可以导致尿α1-MG升高,对肾小管的早期损害作用明显。

Change of urine α1-microglobin in patients proceeding continuous intravenous analgesia with lornoxicam

AIM:To investigate the safety of continuous intravenous analgesia with lornoxicam on kidney by observing the change of α_1-microglobin(α_1MG) in urine. METHODS:Seventy-five patients undergoing various orthopedic surgery were randomly divided into three groups according post-operation analgesia drugs. Group F(n=26) received fentanyl(1.2 mg) with background dose 2 mL·h~(-1),loading dose(0.05 mg) injected intravenously.Group L(n=23) received lornoxicam 72 mg with background dose 2 mL·h~(-1),loading dose 8 mg injected intravenously.Group LF(n=26) received lornoxicam 36 mg and fentanyl(0.9 mg) with background dose 2 mL·h~(-1),loading dose fentanyl(0.025 mg) and lornoxicam 4 mg injected intravenously.All the drugs were dissolved in sodium chloride solution with dilution to 144 mL.Renal function(BUN,UA,Cr) and α_1-MG in urine were measured in the morning before operation and in the forth morning after operation. RESULTS:There were no significant differences of α_1-MG in urine before operation among all groups(P>(0.05)).The increase of α_1-MG in urine after operation in group L and group LF were significantly greater than that in group F(P<(0.01)),and also greater than that before operation((P<0.01)).And there were no significant differences in the indexes of renal function before or after operation among the three groups(P>(0.05)). CONCLUSION:Continuous intravenous analgesia with lornoxicam has no marked effect on renal function,but increase significantly the level of α_1-MG in urine with a potential harm to renal tubules.