两种麻醉方法对肝脏部分切除术后肝功能影响的比较

The Different Effect of Isoflurane and Propofol-Remifentanil on Liver Function in Patients Undergoing Partial Hepatectomy

目的:比较肝脏部分切除术患者丙泊酚-瑞芬太尼靶控静脉麻醉与异氟烷吸入麻醉对肝功能的影响。方法:择期行肝脏部分切除术患者30例,随机分为:丙泊酚-瑞芬太尼组(PR组)和异氟烷组(ISO组),每组15例。PR组靶控输注丙泊酚和瑞芬太尼,血浆靶浓度分别为3.5mg/L和4.2μg/L;ISO组吸入异氟烷(呼气末浓度为1.5%～2.5%)。分别于阻断肝门前(T1),阻断开放后即刻(T2)、30min(T3)、60min(T4),术后1d(T5)、术后3d(T6)取静脉血测定血清丙氨酸氨基转移酶(ALT)、血清天冬氨酸氨基转移酶(AST)、γ-谷氨酰转肽酶(γ-GGT)、乳酸脱氢酶(LDH)、总胆红质(TBIL)浓度,并对结果进行统计学分析。结果:2组ALT比较,ISO组的T5、T6显著高于PR组(P<0.05);ISO组的γ-GGT在T3、T4显著高于PR组(P<0.05);ISO组TBIL在T5、T6显著高于PR组(P<0.05)。结论:与异氟烷麻醉相比,丙泊酚-瑞芬太尼麻醉对肝脏部分切除术患者的肝功能影响较小,对肝细胞具有一定的保护作用。

Objective： To determine the effects of propofol-remifentanil and isoflurane on liver function in patients undergoing partial hepatectomy. Methods ：Thirty ASA Ⅰ-Ⅱ patients undergoing elective partial hepatectomy were randomly divided into 2 groups （n=15 for each）,propofol-remifentanil group （PR） and isoflurane group （ISO）. Anesthesia was maintained with target-controlled-infusion （TCI）of PR（target plasma concentration was set at 3.5mg/mg and 4.2 μg/L）or ISO inhalation （end-tidal isoflurane concentration was 1.5%-2.5% ）. The venous samples were taken at preoperative （T1）,the moment after reperfusion （T2）, 30 min（T3）, 60 min after reperfusion （T4）and 1d （T5）, 3 d （T6） after operation to measure the concentrations of ALT, AST,γ-GGT, LDH, TBIL. Results：At T5 and T6 ALT was significantly higher in group ISO than that in group PR （P〈 0.05）. At T3 and T4 γ-GGT was significantly higher in group ISO than that in group PR （P〈 0.05）. TBIL was significantly higher at T5 and T6 in group ISO than that in group PR （P 〈 0.05）. Conclusion：Compared with isofluranc anesthesia,propofol-remifentanil anesthesia can produce better protective effects on liver function in patients undergoing partial hepatectomy.