CAJ | 학술논문

目的评价七氟醚极低流量麻醉联合Amsorb Plus钙石灰对患者肝肾功能的影响.方法择期拟行胃肠手术患者72例,ASA分级Ⅰ级或Ⅱ级,年龄20 ～ 60岁,采用随机数字表法,将患者随机分为2组(n=36):中流量麻醉组(G1组)和极低流量麻醉组(G2组).CO2吸收罐内放入Amsorb Plus钙石灰,监测并记录其中心温度.机械通气稳定后设定七氟醚挥发罐浓度4％,氧流量4 L/min,呼气末七氟醚浓度达2.6％后,G1组设定氧流量为2 L/min,G2组设定氧流量为0.5 L/min.术中氧流量不变,维持呼气末七氟醚浓度2.4％～2.8％.于术前24 h、术后24h取血样,检测血清AST、ALT活性和总胆红素(TBIL)、直接胆红素(DBIL)、BUN和Cr的浓度,同时采集尿样,检测尿糖和尿蛋白浓度,记录尿糖阳性和尿蛋白阳性的发生情况.结果两组患者不同时点钙石灰中心温度比较差异无统计学意义(P＞0.05).与术前24h时比较,术后24h时G1组血清AST活性、TBIL、DBIL浓度升高,BUN浓度降低(P＜0.05),Cr浓度、尿糖阳性率和尿蛋白阳性率比较差异无统计学意义(P＞0.05),G2组DBIL浓度升高,BUN浓度降低(P＜0.05),其余指标差异无统计学意义(P＞0.05).两组肝肾功能各指标比较差异无统计学意义(P＞0.05).结论七氟醚极低流量麻醉联合Amsorb Plus钙石灰对患者肝肾功能无明显影响,与中流量麻醉无差异,可安全地应用于临床.
목적 평개칠불미겁저류량마취연합Amsorb Plus개석회대환자간신공능적영향.방법 택기의행위장수술환자72례,ASA분급Ⅰ급혹Ⅱ급,년령20 ～ 60세,채용수궤수자표법,장환자수궤분위2조(n=36):중류량마취조(G1조)화겁저류량마취조(G2조).CO2흡수관내방입Amsorb Plus개석회,감측병기록기중심온도.궤계통기은정후설정칠불미휘발관농도4％,양류량4 L/min,호기말칠불미농도체2.6％후,G1조설정양류량위2 L/min,G2조설정양류량위0.5 L/min.술중양류량불변,유지호기말칠불미농도2.4％～2.8％.우술전24 h、술후24h취혈양,검측혈청AST、ALT활성화총담홍소(TBIL)、직접담홍소(DBIL)、BUN화Cr적농도,동시채집뇨양,검측뇨당화뇨단백농도,기록뇨당양성화뇨단백양성적발생정황.결과 량조환자불동시점개석회중심온도비교차이무통계학의의(P＞0.05).여술전24h시비교,술후24h시G1조혈청AST활성、TBIL、DBIL농도승고,BUN농도강저(P＜0.05),Cr농도、뇨당양성솔화뇨단백양성솔비교차이무통계학의의(P＞0.05),G2조DBIL농도승고,BUN농도강저(P＜0.05),기여지표차이무통계학의의(P＞0.05).량조간신공능각지표비교차이무통계학의의(P＞0.05).결론 칠불미겁저류량마취연합Amsorb Plus개석회대환자간신공능무명현영향,여중류량마취무차이,가안전지응용우림상.
Objective To investigate the effects of minimal-flow sevoflurane anesthesia combined with a new CO2 adsorbent Amsorb Plus calcium lime on the hepatic and renal functions in patients.Methods Seventytow ASA Ⅰ or Ⅱ patients,aged 20-60 yr,scheduled for gastrointestinal surgery under general anesthesia,were randomized into 2 groups (n =36 each):middle-flow anesthesia group (group G1 ) and minimal-flow anesthesia group (group G2 ).Amsorb Plus calcium lime was added into the CO2 absorption canister and the core temperature of the calcium lime was continuously monitored and recorded.The patients were tracheal intubated after anesthesia induction and mechanically ventilated.The initial sevoflurane concentration was set at 4％ and the fresh gas flow of oxygen was set at 4 L/min.After the end-tidal concentration of sevoflurane reached 2.6％,the fresh gas flow of oxygen was adjusted to 2 L/min in group G1 or 0.5 L/min in group G2.The end-tidal concentration of sevoflurane was maintained at 2.4％-2.8％ during operation.Venous blood samples were taken 24 h before and 24 h after operation for determination of the serum concentrations of total bilirubin (TBIL),direct bilirubin (DBIL),blood urea nitrogen (BUN) and creatinire (Cr) and activities of alanine aminotransferase (ALT) and aspartate aminotransferase (AST).Urine samples were obtained at 24 h before and after operation to detect the concentration of glucose and protein.The urine glucose and protein positive patients were recorded.Results There was no significant difference in the core temperature of calcium lime at different time points between the two groups ( P ＞ 0.05 ).Compared with that at 24 h before operation,AST activity,TBIL and DBIL concentrations were significantly increased,BUN concentration was significantly decreased,but no significant change was found in the Cr concentration and the number of urine glucose and protein positive patients at 24 h after operation in group G1,and DBIL concentration was significantly increased,while BUN concentration was significantly decreased at 24 h after operation in group G2 ( P ＜ 0.05 ).There was no significant difference in the parameters of hepatic and renal functions between the two groups ( P ＞ 0.05).Conclusion The combination of minimal-flow sevoflurane anesthesia and Amsorb Plus calcium lime exerts no effect on the hepatic and renal functions,the effect is similar to that of middle-flow anesthesia,and it can be safely used in patients.