中华麻醉学杂志
中華痳醉學雜誌
중화마취학잡지
CHINESE JOURNAL OF ANESTHESIOLOGY
2014年
11期
1306-1308
,共3页
麻醉药,吸入%缺血预处理%再灌注损伤%肠%肝切除术
痳醉藥,吸入%缺血預處理%再灌註損傷%腸%肝切除術
마취약,흡입%결혈예처리%재관주손상%장%간절제술
Anesthetics,inhalation%Ischemic preconditioning%Reperfusion injury%Intestines%Hepatectomy
目的 探讨七氟醚预处理对肝癌切除术患者肠损伤的影响.方法 选择右肝癌切除术患者40例,性别不限,年龄20 ～ 60岁,体重50 ～ 75 kg,ASA分级Ⅱ或Ⅲ级,肝功能Child-Pugh分级A级,采用随机数字表法分为2组(n=20):七氟醚预处理组(S组)和对照组(C组).S组气管插管后开始吸入七氟醚,呼气末七氟醚浓度2.0％,持续吸入30 min后洗出.于麻醉诱导前(T0)、肝门阻断即刻(T1)、肝门开放1 h(T2)、开放3 h(T3)、开放6 h(T4)、术后24 h(T5)时抽取动脉血样,采用EHSA法测定血清TNF-α、肠脂肪酸结合蛋白(Ⅰ-FABP)和D-乳酸盐的浓度.结果 2组患者血清TNF-α和D-乳酸盐浓度于T2时开始升高,T4时达峰值,T5时开始下降(P＜0.05);血清Ⅰ-FABP浓度于T2时开始升高,T3时达峰值,T4时开始下降(P＜0.05).与C组比较,S组T2-T5时血清TNF-α、Ⅰ-FABP和D-乳酸盐浓度降低(p＜0.05).结论 七氟醚预处理可抑制机体炎性反应,减轻肝癌切除术患者肠损伤.
目的 探討七氟醚預處理對肝癌切除術患者腸損傷的影響.方法 選擇右肝癌切除術患者40例,性彆不限,年齡20 ～ 60歲,體重50 ～ 75 kg,ASA分級Ⅱ或Ⅲ級,肝功能Child-Pugh分級A級,採用隨機數字錶法分為2組(n=20):七氟醚預處理組(S組)和對照組(C組).S組氣管插管後開始吸入七氟醚,呼氣末七氟醚濃度2.0％,持續吸入30 min後洗齣.于痳醉誘導前(T0)、肝門阻斷即刻(T1)、肝門開放1 h(T2)、開放3 h(T3)、開放6 h(T4)、術後24 h(T5)時抽取動脈血樣,採用EHSA法測定血清TNF-α、腸脂肪痠結閤蛋白(Ⅰ-FABP)和D-乳痠鹽的濃度.結果 2組患者血清TNF-α和D-乳痠鹽濃度于T2時開始升高,T4時達峰值,T5時開始下降(P＜0.05);血清Ⅰ-FABP濃度于T2時開始升高,T3時達峰值,T4時開始下降(P＜0.05).與C組比較,S組T2-T5時血清TNF-α、Ⅰ-FABP和D-乳痠鹽濃度降低(p＜0.05).結論 七氟醚預處理可抑製機體炎性反應,減輕肝癌切除術患者腸損傷.
목적 탐토칠불미예처리대간암절제술환자장손상적영향.방법 선택우간암절제술환자40례,성별불한,년령20 ～ 60세,체중50 ～ 75 kg,ASA분급Ⅱ혹Ⅲ급,간공능Child-Pugh분급A급,채용수궤수자표법분위2조(n=20):칠불미예처리조(S조)화대조조(C조).S조기관삽관후개시흡입칠불미,호기말칠불미농도2.0％,지속흡입30 min후세출.우마취유도전(T0)、간문조단즉각(T1)、간문개방1 h(T2)、개방3 h(T3)、개방6 h(T4)、술후24 h(T5)시추취동맥혈양,채용EHSA법측정혈청TNF-α、장지방산결합단백(Ⅰ-FABP)화D-유산염적농도.결과 2조환자혈청TNF-α화D-유산염농도우T2시개시승고,T4시체봉치,T5시개시하강(P＜0.05);혈청Ⅰ-FABP농도우T2시개시승고,T3시체봉치,T4시개시하강(P＜0.05).여C조비교,S조T2-T5시혈청TNF-α、Ⅰ-FABP화D-유산염농도강저(p＜0.05).결론 칠불미예처리가억제궤체염성반응,감경간암절제술환자장손상.
Objective To evaluate the effect of sevoflurane preconditioning on intestinal injury in the patients undergoing resection for liver cancer.Methods Forty patients of both sexes,aged 20-60 yr,weighing 5075 kg,of ASA physical status Ⅱ or Ⅲ (liver function Child-Pugh grade A),undergoing resection for right liver cancer,were randomly divided into 2 groups (n =20 each):sevoflurane preconditioning group (S group) and control group (C group).Anesthesia was induced with target-controlled infusion of propofol and remifentanil.Tracheal intubation was facilitated with cisatracurium.Anesthesia was maintained with target-controlled infusion of propofol and remifentanil.S group inhaled sevoflurane with the end-tidal concentration of 2.0％ for 30 min starting from the end of intubation,followed by washout.Before induction (T0),immediately after hepatic portal was clamped (T1),at 1,3 and 6 h after occlusion of hepatic portal was released (T2-4) and at 24 h after operation (T5),arterial blood samples were obtained for determination of serum tumor necrosis factor-alpha (TNF-α),intestinal fatty acids binding protein (Ⅰ-FABP) and D-lactate levels.Results The concentrations of serum TNF-α and D-lactate started to rise at T2,peaked at T4,and started to decline at T5,and the serum Ⅰ-FABP concentrations started to rise at T2,peaked at T3,and started to decline at T4 in the two groups.The concentrations of serum TNF-α,Ⅰ-FABP and D-lactate were significantly lower in S group than in C group.Conclusion Sevoflurane preconditioning can inhibit inflammatory responses and reduce intestinal injury in the patients undergoing resection for liver cancer.
