不同剂量七氟醚吸入麻醉用于肝移植患者的临床评价

摘要

Objective To compare the effects in liver function of patients with liver transplantation which were narcotized by different do-ses of sevoflurane. Methods 40 liver transplantation patients were divided into 4 groups,each group including 10 cases. Induction of anesthesia was performed with midazolam 0. 05 mg/ kg,fentanyl 5 μg/ kg,etomidate 0. 3 mg/ kg,vecuronium bromide 0. 15 mg/ kg. Maintenance of anesthe-sia was performed with propofol,sevoflurane. The group of P was infused of propofol 4 mg/(kg·h),the group of S1 was inhaled sevoflurane 0. 5 MAC,the group of S2 was inhaled of sevoflurane 1 MAC,the group of S3 was inhaled of sevoflurane 1. 5 MAC. Record the MAP,HR before an-esthesia,after induction,after tracheal intubation 1 min,5 min,10 min. The indexes were recorded at 5 time points,including before anesthesia (D0),1 d after operation(D1),3 d after operation(D2),5 d after operation(D3)and 7 d after operation(D4)respectively. To determination the level of ALT,AST,TBIL. Results The MAP and HR decreased more significantly in the medium dose sevoflurane group than the other two groups. The levels of ALT,AST with sevoflurane group was less than propofol group. TBIL were a little slower,two groups of TBIL began to in-crease after D1,D4 gradually returned to normal. Conclusion The medium dose of sevoflurane in patients with liver transplantation anesthesia is appropriate. Sevoflurane anesthesia group is no significant difference in liver transplantation patients compared with propofol group.%目的：比较不同剂量七氟醚吸入麻醉对肝移植患者的肝脏功能的影响。方法40例肝移植患者分为4组，每组10例，用咪唑安定0.05 mg·kg -1、芬太尼5μg·kg -1、依托咪酯0.3 mg·kg -1、维库溴胺0.15 mg·kg -1行麻醉诱导；麻醉维持用丙泊酚、七氟醚，丙泊酚组（P 组）：持续输注丙泊酚4 mg·kg -1·h -1，七氟醚低剂量组（S1组）持续吸入七氟醚0.5最小肺泡浓度（MAC），七氟醚中剂量组（S2组）持续吸入七氟醚1.0 MAC，七氟醚高剂量组（S3组）持续吸入七氟醚1.5 MAC；记录麻醉前、诱导后、插管后1 min、5 min、10 min 的平均动脉压（MAP）、心率（HR）；分别于麻醉前（D0）、术后1 d（D1）、术后3 d（D2）、术后5 d（D3）和术后7 d（D4）5个时间点静脉采血，测定丙氨酸氨基转移酶（ALT）、天冬氨酸氨基转移酶（AST）、总胆红素（TBIL）水平。结果以中等剂量七氟醚用于吸入麻醉时其血压和心率下降比其他两组更为明显；七氟醚组 ALT、AST 水平低于丙泊酚组，TBIL 反应稍慢，丙泊酚组在术后第3天达高峰，术后第7天也逐渐恢复正常。两组 TBIL 在 D1开始升高，D4时逐渐恢复正常。结论以中等剂量七氟醚吸入麻醉用于肝癌患者肝移植麻醉为宜；七氟醚麻醉与丙泊酚麻醉相比，对于活体肝脏移植患者的肝功能指标影响无显著差异。