中华麻醉学杂志
中華痳醉學雜誌
중화마취학잡지
CHINESE JOURNAL OF ANESTHESIOLOGY
2008年
12期
1067-1070
,共4页
二异丙酚%哌啶类%异氟醚%芬太尼%肝%再灌注损伤
二異丙酚%哌啶類%異氟醚%芬太尼%肝%再灌註損傷
이이병분%고정류%이불미%분태니%간%재관주손상
Propofol%Piperidines%lsoflurane%Fentanyl%Hepatic%Reperfnsion injury
目的 通过比较异丙酚-瑞芬太尼与异氟烷-芬太尼麻醉下肝切除术患者肝脏缺血再灌注损伤的程度,探讨肝切除术适宜的麻醉方法 .方法 择期行肝部分切除术患者30例,年龄41～64岁,体重58～86 kg,ASA Ⅰ或Ⅱ级,肝功能Child A级,随机分为异丙酚-瑞芬太尼组(PR组)和异氟烷-芬太尼组(IF组),每组15例.静脉注射咪达唑仑、芬太尼、依托咪酯和维库溴铵行麻醉诱导,气管插管后行机械通气.麻醉维持:PR组靶控输注异丙酚(血浆靶浓度3.5 μg/ml)和瑞芬太尼(血浆靶浓度4.2ng/ml);IF组吸入1.5%～2.5%异氟烷,问断静脉注射芬太尼2 μg/kg;2组均间断静脉注射维库溴铵维持肌松.于肝门阻断前(T1)、肝门开放后即刻(T2)、30 min(T3)、60 min(T4)和术后1 d(T5)时取右颈内静脉血样,测定血清谷丙转氨酶(ALT)、谷草转氨酶(AST)、γ-谷氨酰转肽酶(γ-GGT)、乳酸脱氢酶(LDH)、总胆红素(TBIL)、总超氧化物歧化酶(T-SOD)和丙二醛(MDA)的水平.结果 与IF组比较,PR组T5时ALT活性降低,L3、T4时γ-GGT活性降低,T5时T-SOD活性升高,T4、T5时MDA浓度降低(P<0.05).结论 与异氟烷-芬太尼麻醉相比,异丙酚-瑞芬太尼麻醉可减轻患者肝脏缺血再灌注损伤的程度,更适用于肝切除术.
目的 通過比較異丙酚-瑞芬太尼與異氟烷-芬太尼痳醉下肝切除術患者肝髒缺血再灌註損傷的程度,探討肝切除術適宜的痳醉方法 .方法 擇期行肝部分切除術患者30例,年齡41～64歲,體重58～86 kg,ASA Ⅰ或Ⅱ級,肝功能Child A級,隨機分為異丙酚-瑞芬太尼組(PR組)和異氟烷-芬太尼組(IF組),每組15例.靜脈註射咪達唑崙、芬太尼、依託咪酯和維庫溴銨行痳醉誘導,氣管插管後行機械通氣.痳醉維持:PR組靶控輸註異丙酚(血漿靶濃度3.5 μg/ml)和瑞芬太尼(血漿靶濃度4.2ng/ml);IF組吸入1.5%～2.5%異氟烷,問斷靜脈註射芬太尼2 μg/kg;2組均間斷靜脈註射維庫溴銨維持肌鬆.于肝門阻斷前(T1)、肝門開放後即刻(T2)、30 min(T3)、60 min(T4)和術後1 d(T5)時取右頸內靜脈血樣,測定血清穀丙轉氨酶(ALT)、穀草轉氨酶(AST)、γ-穀氨酰轉肽酶(γ-GGT)、乳痠脫氫酶(LDH)、總膽紅素(TBIL)、總超氧化物歧化酶(T-SOD)和丙二醛(MDA)的水平.結果 與IF組比較,PR組T5時ALT活性降低,L3、T4時γ-GGT活性降低,T5時T-SOD活性升高,T4、T5時MDA濃度降低(P<0.05).結論 與異氟烷-芬太尼痳醉相比,異丙酚-瑞芬太尼痳醉可減輕患者肝髒缺血再灌註損傷的程度,更適用于肝切除術.
목적 통과비교이병분-서분태니여이불완-분태니마취하간절제술환자간장결혈재관주손상적정도,탐토간절제술괄의적마취방법 .방법 택기행간부분절제술환자30례,년령41～64세,체중58～86 kg,ASA Ⅰ혹Ⅱ급,간공능Child A급,수궤분위이병분-서분태니조(PR조)화이불완-분태니조(IF조),매조15례.정맥주사미체서륜、분태니、의탁미지화유고추안행마취유도,기관삽관후행궤계통기.마취유지:PR조파공수주이병분(혈장파농도3.5 μg/ml)화서분태니(혈장파농도4.2ng/ml);IF조흡입1.5%～2.5%이불완,문단정맥주사분태니2 μg/kg;2조균간단정맥주사유고추안유지기송.우간문조단전(T1)、간문개방후즉각(T2)、30 min(T3)、60 min(T4)화술후1 d(T5)시취우경내정맥혈양,측정혈청곡병전안매(ALT)、곡초전안매(AST)、γ-곡안선전태매(γ-GGT)、유산탈경매(LDH)、총담홍소(TBIL)、총초양화물기화매(T-SOD)화병이철(MDA)적수평.결과 여IF조비교,PR조T5시ALT활성강저,L3、T4시γ-GGT활성강저,T5시T-SOD활성승고,T4、T5시MDA농도강저(P<0.05).결론 여이불완-분태니마취상비,이병분-서분태니마취가감경환자간장결혈재관주손상적정도,경괄용우간절제술.
Objective To compare the severity of hepatic ischemidreperfusion(I/R)injury caused by partial hepatectomy performed under propofol-remifentanil and isoflurane-fentanyl anesthesia.Methods Thirty ASA Ⅰ or Ⅱ patients aged 41-64 yr weighing 58-86 kg undergoing elective partial hepatectomy were randomly divided into 2 groups(n=15 each):propefol-remifentanil group(PR)and isoflurane-fentanyl group(IF).Anesthesia was induced with midazolam,fentanyl,etomidate and vecuronium.The patients were mechanically ventilated after tracheal intubation.Anesthesia was maintained with TCI of propofol(Cp=3.5μg/ml)and remifentanil(Cp=4.2 ng/ml)in group PR or 1.5%-2.5% isoflurane and intermittent iv boluses of fentanyl in group IF.Muscle relaxation was maintained with intermittent iv boluses of vecuronium in both groups.Blood samples were taken before occlusion of hepatic portal(T1)immediately(T2)and 30,60 min after release of portal occlusion(T3,4)and 1 d after operation(T5),for determination of sernm levels of ALT,AST,γ-GGT,LDH,TBIL,T-SOD and MDA.Specimens were obtained from the liver left intact after partial hepatectomy for ultrastructural examination with electron microscope.ResultsSerum levels of ALT at T5,γ-GGT at T3,4,and MDA at T4,5 were significandy lower while T-SOD at T5 were significantly higher in group PR than in group IF.Electron microscopic examination showed that tissue damages were significantly aRenuated in PR group as compared with IF group.Conclusion Propofol-remifentanil anesthesia can to some extent pmtect the liver against I/R injury during partial hepatectomy by reducing oxygen free radicals.
