七氟醚与异氟醚对肝硬化患者肝脏缺血-再灌注损伤的影响

Effects of sevoflurane and isoflurane inhalation on ischemia-reperfusion injury in patients with liver cirrhosis

目的比较七氟醚和异氟醚麻醉对肝硬化患者肝脏缺血-再灌注损伤的影响。方法60例择期行肝脏部分切除的肝硬化患者,随机均分为七氟醚组（S组）和异氟醚组（I组）,每组30例。两组患者麻醉诱导均静脉注射舒芬太尼0.4μg/kg、依托咪酯0.2-0.3mg/kg和顺苯磺酸阿曲库铵0.2-0.3mg/kg。S组和I组均维持麻醉药呼气末浓度为1.0 MAC,间断静注舒芬太尼、顺苯磺酸阿曲库铵维持麻醉。分别于麻醉诱导前（T0）、肝门阻断前（T1）、阻断开放后即刻（T2）、60 min（T3）、术后1d（T4）、术后3d（T5）取中心静脉血,测定血清谷丙转氨酶（ALT）、谷草转氨酶（AST）、总超氧化物歧化酶（T-SOD）和丙二醛（MDA）的水平。结果与T0及T1时比较,T3-T5时两组AST、ALT含量明显升高（P〈0.05）;T4、T5时两组T-SOD含量明显降低,MDA含量明显升高（P〈0.05）;T3-T5时S组AST、ALT含量明显低于I组（P〈0.05）,T4、T5时T-SOD含量明显高于、MDA含量明显低于I组（P〈0.05）。结论 七氟醚可减轻肝硬化患者肝缺血-再灌注损伤的程度,较适用于肝硬化患者行肝脏部分切除术。

Objective To compare the effects of sevoflurane and isoflurane anesthesia on ischemia-reperfusion injury in patients with liver cirrhosis.Methods Sixty patients with cirrhosis of liver undergoing elective partial hepatic resection,were randomly divided into sevoflurane group（group S）and isoflurane group（group I）,30 cases each.All patients had anesthesia induced with sufentanyl0.4μg/kg,etomidate 0.2-0.3mg/kg and cisatracurium besylate 0.2-0.3mg/kg.For maintenance,sufentanyl and cisatracurium besylate were intermittently and intravenously injected.Both groups maintain the end tidal concentration of inhalation anesthetics on the level of 1.0MAC.Serum levels of alanine aminotransferase（ALT）,aspartate aminotransferase（AST）,total superoxide dismutase（TSOD）and malondialdehyde（MDA）were determined before anesthesia induction（T0）,before occlusion（T1）,at the time hepatic portal occlusion was released（T2）,and 60min（T3）afterwards,and 1d（T4）and 3d（T5）postoperatively.Results Compared with T0 and T1,the serum AST and ALT activities in both groups increased significantly at T3-T5（P〈0.05）.The serum T-SOD activity decreased significantly and MDA concentration increased significantly at T3-T5 as compared with T0 and T1in both groups（P〈0.05）.Compared with group I,the serum AST and ALT activities were significantly lower at T3-T5,MDA concentration was significantly lower and T-SOD activity was significantly higher at T3-T5（P〈0.05）.Conclusion Compared with isoflurane,sevoflurane can reduce the extent of ischemia-reperfusion injury in patients with cirrhosis of liver,and sevoflurane is more suitable for the patients with cirrhosis undergoing liver resection.