CAJ | 학술논문

比较丙泊酚或七氟醚复合瑞芬太尼全麻维持，对行经腹会阴联合直肠癌根治术（Miles 手术）患者机体蛋白质分解代谢的影响。选择40例将要行 Miles 手术的患者，年龄25岁～65岁，ASA Ⅰ级～Ⅱ级，随机分为两组：一组接受丙泊酚复合瑞芬太尼全麻维持（P 组，n＝20）；另一组接受七氟醚复合瑞芬太尼全麻维持（S 组，n＝20）。尿标本自手术开始切皮（0h）每小时收集一次，检测尿液中3-甲基组氨酸（3-M H）与肌酐（Cr）的比值（3-M H／Cr）。呼吸商（RQ）从手术切皮（0h）以后每小时检测一次。结果 P 组与 S 组 T2（1h ～2h）、T3（2h ～3h）的3-M H ／Cr 值与 T0（0h）、T1（0h ～1h）相比，明显升高，且 P 组 T2和 T3的3-M H／Cr 值和 RQ 均比 S 组低。丙泊酚脂肪乳中的甘油三酯可能会作为供能物质被机体分解利用，从而减少体内蛋白质的分解。
비교병박분혹칠불미복합서분태니전마유지，대행경복회음연합직장암근치술（Miles 수술）환자궤체단백질분해대사적영향。선택40례장요행 Miles 수술적환자，년령25세～65세，ASA Ⅰ급～Ⅱ급，수궤분위량조：일조접수병박분복합서분태니전마유지（P 조，n＝20）；령일조접수칠불미복합서분태니전마유지（S 조，n＝20）。뇨표본자수술개시절피（0h）매소시수집일차，검측뇨액중3-갑기조안산（3-M H）여기항（Cr）적비치（3-M H／Cr）。호흡상（RQ）종수술절피（0h）이후매소시검측일차。결과 P 조여 S 조 T2（1h ～2h）、T3（2h ～3h）적3-M H ／Cr 치여 T0（0h）、T1（0h ～1h）상비，명현승고，차 P 조 T2화 T3적3-M H／Cr 치화 RQ 균비 S 조저。병박분지방유중적감유삼지가능회작위공능물질피궤체분해이용，종이감소체내단백질적분해。
This study compared the endocrine-metabolic responses and protein catabolism during gastrectomy in patients who received either sevoflurane or propofol anesthesia with remifentanil .Forty patients (ASA Ⅰ ~ Ⅱ ) aged 25 ~ 65 years undergoing abdominal perineal joint colorectal cancer radical prostatectomy (Miles operation) were randomly assigned to receive intravenous propofol anesthesia with remifentanil (n = 20) or sevoflurane anesthesia with remifentanil (n = 20) . Urine samples were collected every hour after skin incision (0h) and the urinary 3-methyl histidine :creatinine ratio (3-M H /Cr ratio) was used as a marker of protein catabolism .Respiratory quotient was measured during 1h period following skin incision .The 3-M H /Cr ratio significantly increased at 1h ~ 2h and 2h ~ 3h compared to 0 and 0h ~ 1h in both groups , but the propofol group exhibited a lower 3-M H/Cr ratio (nmol/μmol) than the sevoflurane group at 1h ~ 2h and 2h ~ 3h . A difference was observed in the respiratory quotient between the sevoflurane and propofol groups . Protein sparing probably occurs through the utilization of medium-chain triglycerides contained in the fat emulsion of propofol solution as a fuel source .