中华麻醉学杂志
中華痳醉學雜誌
중화마취학잡지
CHINESE JOURNAL OF ANESTHESIOLOGY
2008年
11期
994-996
,共3页
霍树平%常秀杰%朱喜春%赵砚丽
霍樹平%常秀傑%硃喜春%趙硯麗
곽수평%상수걸%주희춘%조연려
二异丙酚%胆囊切除术,腹腔镜%肝功能试验
二異丙酚%膽囊切除術,腹腔鏡%肝功能試驗
이이병분%담낭절제술,복강경%간공능시험
Propofol%Cholecystectomy,laparoscopic%Liver function tests
目的 评价异丙酚对腹腔镜胆囊切除术气腹患者肝功能的影响.方法 择期行腹腔镜胆囊切除术患者50例,ASA Ⅰ或Ⅱ级,年龄18～64岁,随机分为2组(n=25):异氟醚组(Ⅰ组)和异丙酚组(P组).麻醉诱导:静脉注射芬太尼3 gg/kg、依托咪酯0.3 mg/kg和琥珀胆碱1 mg/kg,气管插管后机械通气;麻醉维持:两组均静脉注射维库溴铵1～1.2 mg/kg,每30分钟静脉注射芬太尼1～2 μg/kg和维库溴铵0.5 mg/kg,Ⅰ组吸入异氟醚1.3 MAC,P组靶控输注异丙酚(血浆靶浓度2.0～2.3μg/ml).于麻醉诱导前(T0)和气腹解除后5 min(T1)时抽取肘静脉血样4 ml,检测血浆丙二醛(MDA)浓度、超氧化物歧化酶(SOD)、谷胱甘肽过氧化酶(GSH-PX)活性和总抗氧化能力(T-AOC).于T0及术后24 h(T2)时抽取肘静脉血样2 ml,检测血清谷丙转氨酶(ALT)、谷草转氨酶(AST)活性和总胆红素(T-BIL)浓度.结果 与T0时比较,两组T1时血浆MDA浓度升高,SOD、GSH-PX活性和T-AOC降低,T2时血清ALT、AST、T-BIL水平升高(P＜0.05或0.01);与Ⅰ组比较,P组血浆MDA浓度降低,SOD、GSH-PX活性和T-AOC升高,血清ALT、AST和T-BIL水平降低(P＜0.05).结论 腹腔镜胆囊切除术中靶控输注异丙酚(血浆靶浓度2.0～2.3μg/ml)可减轻CO2气腹诱发肝功能损害,有利于术后早期肝功能的恢复,其机制可能与减轻脂质过氧化反应有关.
目的 評價異丙酚對腹腔鏡膽囊切除術氣腹患者肝功能的影響.方法 擇期行腹腔鏡膽囊切除術患者50例,ASA Ⅰ或Ⅱ級,年齡18～64歲,隨機分為2組(n=25):異氟醚組(Ⅰ組)和異丙酚組(P組).痳醉誘導:靜脈註射芬太尼3 gg/kg、依託咪酯0.3 mg/kg和琥珀膽堿1 mg/kg,氣管插管後機械通氣;痳醉維持:兩組均靜脈註射維庫溴銨1～1.2 mg/kg,每30分鐘靜脈註射芬太尼1～2 μg/kg和維庫溴銨0.5 mg/kg,Ⅰ組吸入異氟醚1.3 MAC,P組靶控輸註異丙酚(血漿靶濃度2.0～2.3μg/ml).于痳醉誘導前(T0)和氣腹解除後5 min(T1)時抽取肘靜脈血樣4 ml,檢測血漿丙二醛(MDA)濃度、超氧化物歧化酶(SOD)、穀胱甘肽過氧化酶(GSH-PX)活性和總抗氧化能力(T-AOC).于T0及術後24 h(T2)時抽取肘靜脈血樣2 ml,檢測血清穀丙轉氨酶(ALT)、穀草轉氨酶(AST)活性和總膽紅素(T-BIL)濃度.結果 與T0時比較,兩組T1時血漿MDA濃度升高,SOD、GSH-PX活性和T-AOC降低,T2時血清ALT、AST、T-BIL水平升高(P＜0.05或0.01);與Ⅰ組比較,P組血漿MDA濃度降低,SOD、GSH-PX活性和T-AOC升高,血清ALT、AST和T-BIL水平降低(P＜0.05).結論 腹腔鏡膽囊切除術中靶控輸註異丙酚(血漿靶濃度2.0～2.3μg/ml)可減輕CO2氣腹誘髮肝功能損害,有利于術後早期肝功能的恢複,其機製可能與減輕脂質過氧化反應有關.
목적 평개이병분대복강경담낭절제술기복환자간공능적영향.방법 택기행복강경담낭절제술환자50례,ASA Ⅰ혹Ⅱ급,년령18～64세,수궤분위2조(n=25):이불미조(Ⅰ조)화이병분조(P조).마취유도:정맥주사분태니3 gg/kg、의탁미지0.3 mg/kg화호박담감1 mg/kg,기관삽관후궤계통기;마취유지:량조균정맥주사유고추안1～1.2 mg/kg,매30분종정맥주사분태니1～2 μg/kg화유고추안0.5 mg/kg,Ⅰ조흡입이불미1.3 MAC,P조파공수주이병분(혈장파농도2.0～2.3μg/ml).우마취유도전(T0)화기복해제후5 min(T1)시추취주정맥혈양4 ml,검측혈장병이철(MDA)농도、초양화물기화매(SOD)、곡광감태과양화매(GSH-PX)활성화총항양화능력(T-AOC).우T0급술후24 h(T2)시추취주정맥혈양2 ml,검측혈청곡병전안매(ALT)、곡초전안매(AST)활성화총담홍소(T-BIL)농도.결과 여T0시비교,량조T1시혈장MDA농도승고,SOD、GSH-PX활성화T-AOC강저,T2시혈청ALT、AST、T-BIL수평승고(P＜0.05혹0.01);여Ⅰ조비교,P조혈장MDA농도강저,SOD、GSH-PX활성화T-AOC승고,혈청ALT、AST화T-BIL수평강저(P＜0.05).결론 복강경담낭절제술중파공수주이병분(혈장파농도2.0～2.3μg/ml)가감경CO2기복유발간공능손해,유리우술후조기간공능적회복,기궤제가능여감경지질과양화반응유관.
Objective To investigate the effects of propofol on hepatic function in patients undergoing laparoscopic cholecystectomy(LC)with CO2 pneumoperitoneum.Methods Fifry ASA Ⅰ orⅡpatients aged 18-64 yr undergoing LC were randomly divided into isoflurane group(Ⅰ)and propofol group(P)(n=25 each).The patients were premedicated with intramuscular atropine 0.5 mg and midazolam 0.03 mg/kg.Anesthesia was induced with fentanyl,etomidate and succinylcholine and maintained with 1.3 MAC isoflurane in group Ⅰ or TCI of propofol(CT=2.0-2.3 μg/ml)in group P.Blood sample were obtained from peripheral vein immediately before induction of anesthesia(T0),at 5 min after induction of CO2 pneumoperitoneum(T1),and 24 h after operation (T2)for determination of plasma concentration of MDA,SOD activity,glutathione peroxidase(GSH-PX)activity and total antioxidant capacity(T-AOC)(at T0 and T1)and serum levels of alanine aminotransferase(ALT),aspartate aminotransferase(AST)and total bilirubin(T-BIL)(at To and T2).Results The plasma concentration of MDA was significantly increased while the SOD and GSH-PX activities and T-AOC were significantly decreased at T1 as compared with the baseline vglues at T0 in both groups.The serum ALT,AST activities and T-BIL concentration were significantly increased at T2 as compared with the baseline values in both groups.The plasma MDA concentration was significantly lower,the SOD and GSH-PX activities and T-AOC were significantly higher and the serum ALT and AST activities and T-BIL concentration were significantly lower in group P than in group Ⅰ(P＜0.05).Conclusion Propofol administered by TCI(CT=2.0-2.3μg/ml)during LC can ameliorate hepatic dysfunction induced by CO2 pneumoperitoneum through decrease in lipid poroxidation.
