不同麻醉药物行全身麻醉复合硬膜外阻滞对肝脏切除术后肝肾功能的影响

doi:10.3969/j.issn.1006-7795.2017.03.005

摘要/Abstract

摘要： 目的探讨不同麻醉药物行全身麻醉复合硬膜外阻滞对肝脏切除术后肝肾功能的影响。方法选取首都医科大学附属北京地坛医院2014年10月至2015年10月全身麻醉复合硬膜外阻滞下肝脏切除术病人123例。采用数字表法随机抽样将研究对象分为3组（每组41例），A组病人采用七氟醚吸入全身麻醉，B组病人采用异氟醚吸入全身麻醉，C组病人采用丙泊酚静脉全身麻醉，比较3组病人不同时间点肝肾功能指标。结果术后3组病人丙氨酸氨基转移酶（alanine aminotransferase，ALT）、门冬氨酸氨基转移酶（aspartate transaminase，AST）、碱性磷酸酶（alkaline phosphatase，ALP）、总胆红素（total bilirubin，TBiL）、γ-谷氨酰转肽酶（γ-glutamyltranspeptidase，γ-GT）、尿素氮（urea nitrogen，BUN）、血肌酐（serum creatinine，SCr）、α1-微球蛋白（α1-microglobulin，α1-MG）、白蛋白（albumin，ALB）、乳酸脱氢酶（lactic dehydrogenase，LDH）均表现为升高后降低（P<0.05）。B组病人术后1、3 d时ALT、AST、ALP、TBiL、γ-GT、BUN、SCr、α1-MG、ALB、LDH高于A组，差异有统计学意义（P<0.05）。C组病人术后1 d、3 d时ALT、AST、ALP、TBiL、γ-GT、BUN、SCr、α1-MG、ALB、LDH高于A组和B组，差异有统计学意义（P<0.05）。结论肝脏切除术中，七氟醚、异氟醚、丙泊酚均可用于全身麻醉复合硬膜外阻滞。七氟醚对病人术后肝肾功能的影响更小，安全性更高。

关键词: 七氟醚, 异氟醚, 丙泊酚, 肝脏切除术, 肝肾功能

Abstract: Objective To explore the influence of different anesthetic drugs for general anesthesia combined with epidural block on liver and kidney function after liver resection. Methods Totally 123 patients with liver resection were selected from Beijing Ditan Hospital who underwent general anesthesia combined with epidural block from October 2014 to October 2015. Patients were divided into three groups by simple random sampling. Forty-one patients were treated with sevoflurane as group A. Another 41 patients were treated with isoflurane as group B. Additional 41 patients were treated with propofol as group C. The result of liver and kidney function tests at different time points were compared among the three groups. Results After operation,alanine aminotransferase (ALT), aspartate transaminase (AST), alkaline phosphatase (ALP), total bilirubin (TBiL), γ-glutamyltranspeptidase (γ-GT), urea nitrogen (BUN), serum creatinine (SCr), α1-microglobulin (α1-MG), albumin (ALB), lactic dehydrogenase (LDH) increased firstly and then decreased in each of the three groups(P<0.05). ALT, AST, ALP, TBiL, γ-GT, BUN, SCr, α1-MG, ALB, LDH at postoperative day 1, day 3 in group B were higher than those of group A(P<0.05). ALT, AST, ALP, TBiL, γ-GT, BUN, SCr, α1-MG, ALB, LDH at postoperative day 1, day 3 in group C were higher than those of group A and B(P<0.05). Conclusion In liver resection, sevoflurane, or isoflurane, propofol can be used for general anesthesia combined with epidural block. Sevoflurane showed less effect on liver and kidney function, and had more safety profile.

Key words: sevoflurane, isoflurane, propofol, liver resection, liver and kidney function

中图分类号:

R614

蔡晓飞, 牛少宁, 丁乔, 程灏. 不同麻醉药物行全身麻醉复合硬膜外阻滞对肝脏切除术后肝肾功能的影响[J]. 首都医科大学学报, 2017, 38(3): 352-356.

Cai Xiaofei, Niu Shaoning, Ding Qiao, Cheng Hao. Influence of general anesthesia combined with epidural block on liver and kidney function after liver resection[J]. Journal of Capital Medical University, 2017, 38(3): 352-356.

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