Objective To investigate the effect of sevoflurane intravenous-inhalation combined anesthesia on liver function,renal function,and cellular immune function in surgical patients with hepatitis cirrhosis.Methods 62 surgical patients with hepatitis cirrhosis treated in our hospital from March 2014 to March 2015 were selected and randomly divided into observation group (31 cases) and control group (31 cases).Within 24 hours before surgery,various types of drugs of the two groups disabled,opening the peripheral vein after into the operating room,routine testing of oxygen saturation,blood pressure,electroencephalogram,electrocardiogram,intramuscular injection of phenobarbital sodium and atropine before anesthesia.The observation group was treated with intravenous-inhalation combined anesthesia [anesthesia induction:intravenous injection of fentanyl 3μg,etomidate injection 0.2 mg/kg,midazolam injection 0.05 mg/kg,cis-atracurium 0.2 mg/kg;anesthesia maintenance:inhalation of 3％ sevoflurane,continuous injection of paracetamol atracurium 0.2 mg/(kg·h),remifentanil 0.2μg/(kg·h)],while the control group was treated with total intravenous anesthesia [anesthesia induction:propofol 2 mg/kg instead of etomidate,anesthesia maintenance:continuous injection of propofol injection 5 mg/(kg·h) instead of sevoflurane,other narcotic drugs with the observation group].Compared liver function,renal function,and cellular immune function of two groups before anesthesia (t1),2 h after induction (t2),1 d after operation (t3),recorded the adverse reactions that occurred within 24 hours after operation.Results In two groups,the levels of ALT,Scr,and BUN at t2 were significantly higher than those at t1 (P＜0.05),the levels ofALB,CD4+,CD4+/CD8+,NK at t2 were significantly lower than those at t1 (P＜0.05),but the change range of observation group was significantly less than that of control group (P＜0.05).There were no statistically significant differences in the incidences of respiratory depression,dizziness and headache,nausea and vomiting,sore throat,muscular flutter,lethargy,cough,and other adverse reactions within 24 hours after surgery between the two groups (P＞0.05).Conclusion In the treatment of patients with hepatitis cirrhosis,sevoflurane intravenous-inhalation combined anesthesia mildly affect the liver and renal function,cellular immune function,which is conducive to immune function recovery,safe and reliable,worthy of clinical application.%目的 探讨七氟醚静吸复合麻醉对肝炎肝硬化手术患者肝功能、肾功能及细胞免疫功能的影响.方法 选择2014年3月至2015年3月医院择期行手术治疗的肝炎肝硬化患者62例随机分为观察组31例和对照组31例.2组患者术前24 h停用各类药物,入室后开放外周静脉,常规检测血氧饱和度、血压、脑电图、心电图,麻醉前肌注苯巴比妥钠、阿托品.观察组采用静吸复合麻醉,麻醉诱导:静脉注射芬太尼3μg,依托咪酯注射液0.2 mg/kg,咪达唑仑注射液0.05 mg/kg,注射用顺苯磺阿曲库铵0.2mg/kg;麻醉维持:吸入3％七氟醚,持续泵入注射用顺苯磺阿曲库铵0.2 mg/(kg·h),注射用盐酸瑞芬太尼0.2μg/(kg·h).对照组采用全凭静脉麻醉,麻醉诱导时丙泊酚注射液2 mg/kg代替依托咪酯注射液,麻醉维持持续泵入丙泊酚注射液5 mg/(kg·h)代替七氟醚,其他麻醉药物同观察组.比较2组患者麻醉前(t1)、诱导后2h(t2)、术后1d (t3)时段肝肾功能、细胞免疫功能情况,并记录术后24h不良反应发生情况.结果 2组患者t2时ALT、Scr、BUN显著高于t1时,ALB、CD4+、CD4+/CD8+、NK明显低于t1时(P＜0.05),但观察组变化幅度明显小于对照组(P＜0.05);2组患者术后24 h内发生呼吸抑制、头晕头痛、恶心呕吐、咽喉疼痛、肌颤、嗜睡、咳嗽无力不良反应发生情况比较,差异无统计学意义(P＞0.05).结论 七氟醚静吸复合麻醉对肝炎肝硬化患者手术肝肾功能、细胞免疫功能影响较小,有利于免疫功能恢复,安全可靠,值得临床推广应用.
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