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今日推出第一期：麻醉与肾移植，其中包括肾移植及肾衰竭患者麻醉方法的探讨和药物代谢规律研究等，希望战友们积极参与！

1: Eur J Anaesthesiol. 2005 Dec;22(12):929-32. 译者ID：md518880
Pharmacodynamics of rocuronium 0.3 mg kg(-1) in adult patients with and without renal failure.
2: Transplant Proc. 2005 Jun;37(5):2020-2. 译者ID： gdy1234
A randomized study comparing combined spinal epidural or general anesthesia for renal transplant surgery.
３: Paediatr Anaesth. 2005 Mar;15(3):220-8. 译者ID：lijing0035
Anesthesia for pediatric renal transplantation with and without epidural analgesia--a review of 7 years experience.
４: Transplant Proc. 2004 Dec;36(10):2954-8. 译者ID： lijing0035
Regional versus general anesthesia for donor nephrectomy: effects on graft function.
５: J Med Assoc Thai. 2004 Jan;87(1):73-9. 译者ID:258444117
A comparison of the efficacy of cisatracurium and atracurium in kidney transplantation operation.
６: Chin Med J (Engl). 2002 Nov;115(11):1692-6. 译者ID：荆山玉
Selection of neuromuscular blocking agents in patients undergoing renal transplantation under general anesthesia.
７: J Clin Anesth. 2001 May;13(3):193-7. 译者ID：saga_2004
Increased sensitivity to vecuronium and prolonged duration of its action in patients with end-stage renal failure.
8: Reg Anesth. 1997 Jan-Feb;22(1):16-23. 译者ID: DXYICU
Epidural analgesia improves outcome following pediatric fundoplication. A retrospective analysis.
９: Anaesth Intensive Care. 2002 Oct;30(5):584-7. 译者ID:zhan07912
Evaluation of induction doses of propofol: comparison between endstage renal disease and normal renal function patients. １０: Paediatr Anaesth. 2002 Jul;12:507-10. 译者ID：saga_2004
Time-course of action of rocuronium 0.3 mg.kg-1 in children with and without endstage renal failure.


文题：0.3 mg /kg 罗库溴铵在患有或不患有肾衰的成年患者的药效动力学
杂志名称：欧洲麻醉学杂志 2005 12：22（12）929-32
背景和目标：与无肾衰的患者相比，肾衰患者在异丙酚静脉麻醉过程中，使用0.6mg/kg罗库溴铵行肌松时的神经肌肉效应是延长的。本文旨在描述异丙酚静脉麻醉下0.3mg/kg罗库溴铵对肾功能衰竭患者的神经肌肉效应，并与无肾衰患者比较神经肌肉效应的差别。
方法：在取得公共机构许可及征得患方同意后，患有肾衰及无肾衰的患者各18例参加了该次前瞻性开放标签研究。肾衰患者被给予或者肾移植或旁路分流术。以1－2mg/kg异丙酚及2ug/kg芬太尼静脉诱导成功后，静脉给予 0.3mg/kg罗库溴铵。然后给予6－12mg/kg/h剂量维持麻醉。利用表面电极，以每15秒钟2Hz大小的刺激强度进行刺激。当对尺神经获得最大强度的刺激，拇指会出现4种肌电反应（四个成串刺激）。记录反应出现的时间，恢复到第一个肌 颤搐的25%所需的时间，以及恢复到四个成串刺激中第一个肌颤搐的0.7大小需要的时间。以Wilcoxon 秩和检验来比较药效动力学的区别，了解 药物种类、性别以及电解质情况是否影响阻滞持续时间。P<0.05表示具有统计学意义。
结果：两组间罗库溴铵的神经肌肉阻滞效应无统计学意义。但两组间总的阻滞持续时间具有显著性差异(P<0.00001)。
结论：当肾衰患者短期内行支气管插管或神经阻滞时，使用0.3mg/kg罗库溴铵是合适的。其中支气管插管可以在4分钟内配合完成气管插管。而神经（肌肉）阻滞（效应）则可在20分钟内被逆转。
PMID: 16318664
译者ID：md518880
杂志全名：Eur J Anaesthesiol. 欧洲麻醉学杂志
年份，卷（期）: 起止页码：2005 12：22（12）929-32
作者：Robertson EN, Driessen JJ, Vogt M, De Boer H, Scheffer GJ
英文摘要：[color=blue]BACKGROUND AND AIM: The neuromuscular effects of a bolus dose of rocuronium 0.6mg kg(-1) under propofol anaesthesia in renal failure patients are prolonged compared to healthy patients. The present study aims to describe the neuromuscular effects of 0.3 mg kg(-1) rocuronium under propofol anaesthesia in patients with renal failure and to compare these effects with healthy control patients. METHODS: With institutional approval and informed consent, 18 healthy patients and 18 patients with renal failure took part in this prospective open label study. The renal failure patients were undergoing either renal transplantation or insertion of a shunt. Rocuronium 0.3 mg kg(-1) was given intravenously after induction of anaesthesia with propofol 1-2 mg kg(-1) and fentanyl 2 microg kg(-1). Propofol 6-12 mg kg(-1) h(-1) was used for maintenance of anaesthesia. Four acceleromyographic responses of the thumb after supramaximal stimulation of the ulnar nerve using surface electrodes at 2 Hz every 15 s were measured and recorded. The onset time, the time to recovery of the first twitch to 25% recovery and the time to a train-of-four ratio of 0.7 were all recorded. Wilcoxon rank sum testing was used to compare the pharmacodynamics and to see if medication, gender or electrolytes influenced the duration of the block. P < 0.05 was significant. RESULTS: No statistical differences were seen in the neuromuscular blocking effects of rocuronium between the two groups but there was a significant difference (P < 0.00001) in the variability of the total duration of the block. CONCLUSIONS: Rocuronium 0.3 mg kg(-1) is suitable for use in patients with renal failure when endotracheal intubation and neuromuscular block for a short period of time are needed. Tracheal intubation is facilitated within 4 min and the block can be antagonized within 20 min.
PMID: 16318664 [PubMed - indexed for MEDLINE]


文题：肾移植手术应用联合腰硬麻醉或全身麻醉的一项随机性研究
译文：INTRODUCTION: 肾移植手术所需的适宜麻醉既要充分镇痛和维持生命体征，又要使患者和移植的器官受影响最小。本研究旨在通过术前、术中的血流动力学和血气分析改变评价不同的麻醉方法对肾移植患者预后的影响。METHODS:50名接受肾移植的成人患者随机分为两组：分别接受规范化的全身麻醉和腰硬联合麻醉。 RESULTS: 入选人员统计、总的麻醉时间(202 +/- 53 vs 186 +/- 37 minutes)和手术时间(191 +/- 52 vs 162 +/- 31 minutes)无显著性差异。诱导前和诱导后5，15，20，30，60分钟的心率和收缩压无显著性差异。发生心动过缓（4例对2例）和低血压（6例对4例）的频率亦无差异。CONCLUSION: 对于全身麻醉来说，区域麻醉在成人肾移植手术麻醉中也是个不错的选择。
译者ID： gdy1234
杂志全名： Transplant Proc.
年份，卷（期）: 起止页码：2005 Jun;37(5):2020-2.
作者：Hadimioglu N, Ertug Z, Bigat Z, Yilmaz M, Yegin A.
英文摘要：INTRODUCTION: The appropriate anesthesia for renal transplantation requires minimal toxicity for patients and for the transplanted organ, as well as sufficient pain relief and maintenance of vital functions. The aim of this study was to determine how the anesthetic technique influences the outcome in patients after renal transplantation in terms of preoperative and intraoperative hemodynamic changes and blood gas changes. METHODS: Fifty adult patients undergoing renal transplantation were randomly divided into two groups receiving standardized general anesthesia or combined spinal and epidural anesthesia. RESULTS: Demographically both groups were similar. Total anesthesia time (202 +/- 53 vs 186 +/- 37 minutes) and surgical time (191 +/- 52 vs 162 +/- 31 minutes) did not differ between the groups. The heart rate and systolic blood pressure values of the groups as measured before induction and 5, 15, 20, 30, as well as 60 minutes thereafter did not differ between the groups. Neither the frequency of bradycardia (four vs two) nor of hypotension (six vs four) during anesthesia differed between regional versus general anesthesia groups. CONCLUSION: Regional is an important alternative to general anesthesia during renal transplantation surgery in adult patients.


文题：区域麻醉与全身麻醉行供肾切除术对移植物功能的作用比较
中文译文：各种区域麻醉及全身麻醉已经成功地应用于活体供肾移植术。此研究对全身麻醉下及联合腰硬麻醉下行供肾切除术后肾移植物的功能进行对比。研究组包括两组受者：第一组移植物取自全麻下供肾切除术（全麻组：10例）；第二组移植物取自联合腰硬麻醉下供肾切除术（联合腰硬麻醉组：10例）。移植过程均使用标准连硬麻。分别在第3天和第7天用闪烁扫描和多普乐超声评估移植物功能，并测定24小时尿中微量白蛋白、肌酐、肌酐清除率的水平。结果显示无论在第3天还是第7天，两组的肾小球滤过率、尿微量白蛋白、肌酐清除率无显著差异。两组的闪烁扫描亦无差别（p>0.5)。第7天的超声示：联合腰硬麻醉组的肾动脉的平均收缩期流量峰值明显比全麻组高（p=0.035)。这种结果提示在全麻下及联合腰硬麻醉下行供肾切除术，对术后移植物作用相似。
译者ID： lijing0035
杂志全名： Transplant Proc.
年份，卷（期）: 起止页码：2004 Dec;36(10):2954-8.
作者:Sener M, Torgay A, Akpek E, Colak T, Karakayali H, Arslan G, Haberal M.
英文摘要:Various general and regional anesthesia methods are used successfully in living-donor kidney transplantation. This study compared kidney graft function after general versus combined spinal-epidural anesthesia for donor nephrectomy. The study groups included recipients who received grafts from donors who had undergone nephrectomy under general anesthesia (GA group; n=10), and recipients who received grafts from donors who had combined spinal-epidural anesthesia (CSE group, n=10). Standard continuous epidural anesthesia was administered during all transplantations. Graft function was assessed using scintigraphy and Doppler ultrasonography on days 3 and 7. Urine levels of microalbumin, creatinine, and creatinine clearance rate were measured/calculated in 24-hour urine samples collected on postoperative days 3 and 7. There were no differences on either day 3 or day 7 with respect to glomerular filtration rate, microalbuminuria, or creatinine clearance rate (P >.05 for all). There were also no differences between the groups with respect to other scintigraphic findings on day 3 or day 7 (P >.05 for all). Ultrasonography on day 7 showed significantly higher mean peak systolic flow in the main renal artery in the CSE group than in the GA group (P=.035). The results suggest that GA and CSE for donor nephrectomy have similar effects on kidney graft function in recipients.
PMID: 15686669 [PubMed - indexed for MEDLINE]


文题：丙泊酚诱导剂量的评估：肾病终末期与正常肾功能患者之间的比较
杂志名称：麻醉重症监护，2002 ，10：30（5）：584－7
作者：Goyal P , Puri GD , Pandey CK , Srivastva S
译文：肾衰患者的贫血，低蛋白质血症 ，以及体内的酸性PH能改变麻醉药物的药代动力学及药效动力学，导致所需麻醉药物剂量的改变。通过运用临床参数判断滴定到临床催眠状态，以及运用一种更为客观的催眠状态的判断指标，双光谱指数（BIS）监护仪，我们对于成人终末期肾病患者的丙泊酚剂量进行评估。其剂量是与正常肾功能患者进行比较。对于27例肾病终末期患者及27例正常肾功能患者，我们通过注射点滴法对于达到临床滴定终点所需丙泊酚剂量进行评估，对于达到BIS均值为50，SD为5的BIS终点所需的丙泊酚剂量也予以评估。每隔15妙便用丙泊酚0.2mg/Kg直至完成这两终点。为达到临床终点所需的丙泊酚用量在肾病终末期患者组（均值1.42mg/Kg,SD 0.24mg/Kg）显著高于肾功能正常组(均值0.89mg/Kg,SD 0.2mg/Kg),P<0.05(非配对t检验)。为达到BIS终点所需的丙泊酚剂量在肾病终末期患者组(均值2.03 mg/Kg，SD 0.4mg/Kg)也显著高于肾功能正常组（均值1.39 mg/Kg，SD 0.43mg/Kg), P<0.05. 丙泊酚用量与术前血红蛋白浓度呈负相关。伴随贫血的肾衰患者的高动力循环可能是其所需更多丙泊酚剂量的原因。
译者ID:zhan07912

Anaesth Intensive Care. 2002 Oct;30(5):584-7.

Evaluation of induction doses of propofol: comparison between endstage renal
disease and normal renal function patients.

Goyal P, Puri GD, Pandey CK, Srivastva S.

Anaemia, hypoproteinaemia and acidic pH in renal failure patients can alter the pharmacokinetics and pharmacodynamics of anaesthetic agents, resulting in altered dose requirements. We evaluated the induction dose of propofol in adult patients with end-stage renal disease by titrating the hypnotic effect by means of a clinical parameter as well as using a more objective assessment of hypnosis, the Bispectral Index (BIS) monitor. The dose was compared with that for patients with normal renal function. Propofol doses that provided the clinical end-point of hypnosis (syringe drop method), as well as the end-point of a mean (SD) BIS value of 50 (5), were evaluated in 27 end-stage renal disease and 27 normal renal function patients. Propofol was administered at 0.2 mg/kg every 15 seconds until these end-points were achieved. End-stage renal disease patients required significantly higher propofol doses to achieve the clinical end-point of hypnosis (1.42 (0.24) mg/kg versus 0.89 (0.2) mg/kg in normal renalfunction patients, P<0.05 unpaired "t" test). Propofol dose required to achieve a BIS of 50 (5) was also higher in end-stage renal disease patients (2.03 (0.4) mg/kg versus 1.39 (0.43) mg/kg in normal renal function patients, P<0.05). There was a significant negative correlation of propofol dose with preoperative haemoglobin concentration. A hyperdynamic circulation in renal failure patients with anaemia may be responsible for the higher propofol dose requirement in this group.
PMID: 12413256 [PubMed - indexed for MEDLINE]