异丙酚与安氟醚或七氟醚静吸复合麻醉对肝功能的影响

Effect of propofol-enflurane or propofol-sevoflurane combining anaesthesia on liver function

目的 :观察异丙酚与安氟醚和七氟醚静吸复合麻醉对肝功能的影响。方法 :32例择期非肝胆系统手术的全麻病人 ,随机分为 4组 ,每组 8例 ,分别给予安氟醚麻醉 ( A组 )、七氟醚麻醉( B组 )、异丙酚 -安氟醚麻醉 ( C组 )、异丙酚 -七氟醚麻醉 ( D组 )。其中 A、B组为对照组 ,C、D组为观察组。分别于麻醉前、麻醉诱导后 2 h和术后 3d采集静脉血测血清丙氨酸转氨酶 ( ALT)、碱性磷酸酶 ( ALP)、白蛋白 ( ALB)、总胆红素 ( TBIL)。结果 :A组和 B组在术后 3d ALT值高于麻醉前( P<0 .0 1 ) ,但未超出正常值范围 ,二组间比较差异无显著性 ( P>0 .0 5 ) ;4组患者在麻醉诱导后2 h ALB值低于麻醉前 ( P<0 .0 5 ) ,但术后 3d各组的 ALB值均恢复正常 ,而且各组间比较差异均无显著性 ( P>0 .0 5 ) ;其余各项指标全程均无显著变化 ( P>0 .0 5 )。结论 :安氟醚和七氟醚两者均有潜在的、轻度的肝毒性 ;临床麻醉剂量的异丙酚能有效防止转氨酶的升高 ,对安氟醚及七氟醚所致肝脏损伤具有明显的保护作用 ;异丙酚复合安氟醚、七氟醚麻醉 ,是一种理想的静吸复合麻醉方法。

Objective:To investigate the effect of propofol enflurane or propofol sevoflurane combining anaesthesia on liver function. Methods:Thirty two adult patients,scheduled for selective non hepatic surgery under general anaesthesia,were randomly allocated to receiving enflurane fentanyl (Group A, n =8),sevoflurane fentanyl (Group B, n =8),propofol enflurane fentanyl (Group C, n =8) and propofol sevoflurane fentanyl (Group D, n =8) ,respectively,to maintain anaesthesia . Group A and Group B served as control groups. From the blood were taken specimens all thirty two patients, before aesthesia, 2 h after induction and 3 d after operation to measure the serum concentration of ALT, ALP, ALB and TBIL,repectively.Results: There was obvious increase in the serum concentration of ALT in group A and group B within normal reference range ( P <0 01). The serum concentration of ALB was obviously decreased 2 h after induction in all four groups ( P <0 05 ), but returned to normal 3 d after operation . There were no any significant difference among four groups, either ( P >0 05). There were no significant differences in other parameters. Conclusion:Both enflurane and sevoflurane have slight potential liver toxicity ;Propofol in clinical dose can obviously prevent the increase of aminotransferase activity and protect the liver from toxicity caused by enflurane and sevoflurane; combined propofol enflurane or propofol sevoflurane anaesthesia is a ideal general anaesthetic method.