异丙酚麻醉对肝叶切除术患者肝功能与一氧化氮/内皮素-1比例的影响

Effect of propofol anesthesia on liver function and nitric oxide/endothelin-1 ratio in patients with hepatic lobectomy

目的观察异丙酚麻醉对肝叶切除术患者肝功能与一氧化氮(NO)/内皮素-1(ET-1)比例的影响。方法观察组于麻醉插管后异丙酚5 mg/(kg.h)微泵持续静脉输注,对照组予以等量生理盐水微泵持续静脉输注,余同观察组。观察并比较两组患者肝门阻断前(T1)、肝门阻断末(T2)和术后第3天(T3)肝功能谷丙转氨酶(ALT)、谷草转氨酶(AST)和血浆NO、ET-1含量的变化。结果肝门阻断末两组患者ALT和AST水平均明显上升(P<0.05或P<0.01),且对照组上升幅度明显高于观察组(P<0.05),术后第3天两组患者ALT和AST水平均恢复至肝门阻断前水平。同时肝门阻断末两组患者血浆NO水平明显下降,血浆ET-1水平明显上升(P<0.05或P<0.01),且对照组上升幅度明显高于观察组(P<0.05),术后第3天两组患者血浆NO和ET-1水平均恢复至肝门阻断前水平。结论肝叶切除术可引起血浆NO/ET-1的比例失衡,血管内皮细胞功能紊乱。异丙酚对肝叶切除术患者具有保护作用,能调节患者血浆NO/ET-1比例的失衡,保护血管内皮功能。

Objective To observe the effects of propofol anesthesia on liver function and nitric oxide/endothelin-1 ratio in patients with hepatic lobeetomy. Methods The patients in observation group were given continuous infusion of propofol 5 mg/（kg·h） by micro-pump after anesthetic intubation, and the control group received continuous intravenous infusion of normal saline by micro pumps. The rest was the same as the observation group were observed and compared liver alanine aminotransferase （ALT）, aspartate aminotransferase （AST） and plasma NO, ET-1 levels changes in the two groups of patients before portal triad clamping （T1）, portal triad clamping end stage （T2） and 3 days after operation （T3）. Results ALT and AST were significantly increased （P 〈 0.05 or P 〈 0.01） at the end of portal triad clamping in two groups of patients, and the range of increase in the observation group was significantly higher than the control group （P 〈 0.05）, 3 days after opera- tion ALT and AST levels were restored to the levels before the hepatic portal blocking in both groups of patients. At the same time plasma NO levels were significantly decreased, plasma ET-1 levels were significantly increased （P 〈 0.05 or P 〈 0.01） at the end of portal triad clamping in two groups of patients. And the rise in the control group was significantly higher than that in the observation group （P 〈 0.05）. Plasma NO and ET-1 levels were restored to the levels before the hepatic portal blocking 3 days after operation in both groups. Conclusion Hepatic lobectomy may cause imbalance in the ratio of plasma NO/ET-1 and vascular endothelial cell dysfunction. Propofol has a protective effect in patients with hepatic lobectomy. It can adjust the imbalance in the proportion of NO/ET-1 and protect endothelial function.