胆碱酯酶用于评估肝硬化患者全身静脉麻醉术前肝储备功能的价值

ChE alteration in patients with cirrhosis for measuring hepatic reserve function for anesthesia

目的评价胆碱酯酶(ChE)检测对肝硬化全身静脉麻醉作为术前肝储备功能评估的可行性、可靠性和准确性。方法选择48例择期腹部非肝脏手术的肝硬化患者,肝脏功能Child-PughA、B级,根据胆碱酯酶检测值将患者分为两组,胆碱酯酶(≥4000u/L)为A组(n=24),胆碱酯酶(<4000u/L)为B组(n=24)。麻醉诱导TCI丙泊酚血浆靶浓度设为3μg/mL,同时输注瑞芬太尼血浆靶浓度4ng/mL,根据BIS值的变化(40～60)调整维持麻醉的靶控浓度。结果两组患者丙泊酚用量差异无统计学意义(P>0.05),但是B组较A组瑞芬太尼用量、维库溴铵用量却显著减少(分别为P<0.01和P<0.05)。在麻醉恢复期,虽然两组患者丙泊酚TCI停止时预期清醒的时间差异无统计学意义(P>0.05),然而B组较A组拔出导管时间明显延长,OAA/S评分减低,差异有统计学意义(P<0.01)。结论术前胆碱酯酶活力能很好地反映肝硬化患者的肝储备功能,对麻醉恢复情况有良好的预计性。

Objective To evaluate the feasibility and efficacy of cholinesterase（ChE） alteration for measuring hepatic reserve function for anesthesia.Methods Forty-eight adult patients with hepatic cirrhosis （group A,B） scheduled for abdominal surgery were enrolled.Patients were divided into two groups , group A （ChE≥4 000 u/L,n=24）.and group B （ChE4 000 u/L,n=24）.Anesthesia was induced by using a TCI of propofol with an initial target plasma concentration of 3 μg/mL, the other TCI of remifentanil with an target plasma concentration of 4 ng/mL, after loss of consciousness the patients were given vecuronium 0.1 mg/kg.the trachea was intubated after muscle relaxants, and the lungs ventilated to obtain an end-tidal carbon dioxide partial pressure of 35-45 mm Hg.Anesthesia was maintained by using the two TCI, which were adjusted to maintain a BIS values ranging between 40~60 and boluses of vecuronium intravenous injection to ensure relaxation throughout surgery.Results While terminated propofol TCI,anticipate recovers consciousness times were no statistically differences（P0.05）.However, recovers consciousness and extubation times of the patients of group B were significantly longer as compared to group A′s, the times of group A were 15.71±13.12 min ; group B were 30.67±17.49min respectively（P0.01）.And OAA/S （The Observer′s Assessment of Alertness/Sedation Scale） scores of the patients of group B were significantly lower than group A′s（P0.01）.Conclusion ChE alteration is a feasible and ideal method to measure hepatic reserve function,which can be used to evaluate the hepatic reserve function in patients with liver cirrhosis in anesthesia.