比较两种丙泊酚制剂对儿童肝脏功能及甘油三酯水平的影响

Comparison of Hepatic Function and Serum Triglyceride Levels with Two Different Kinds of Propofol Preparation in Pediatric Patients

目的比较短时间持续输注丙泊酚长链脂肪乳和丙泊酚中／长链脂肪乳对儿童肝脏功能及甘油三酯水平的影响。方法选择择期行扁桃体、腺样体切除术的儿童患者60例，患儿年龄4—12岁，ASAI～Ⅱ级。将患儿随机分为A、B两组，每组30例。A组使用AstraZenecaUKLimited厂家生产的丙泊酚长链脂肪乳（得普利麻，规格50ml／500mg），B组使用FreseniusKabiDeutschlandGmbH厂家生产的丙泊酚中／长链脂肪乳（竞安，规格20ml／200mg）。分别在麻醉诱导前（T0）、手术结束时（T1）和手术结束后4h（T：）抽取静脉血，检测甘油三酯（TG）、谷丙转氨酶（ALT）、谷草转氨酶（AST）、血清淀粉酶（AMY）含量。结果与T0时比较，A组在T1、T2时的TG值和AMY值明显上升（P〈0．05），B组在T1、T2时的AMY值明显上升（P〈0．05），在T。时的TG值明显上升（P〈0．05），在T2时的TG值与T。时比较未见明显变化（P〉0．05）。与T0时比较，A、B两组在T1、T2时的ALT、AST值未见明显变化（P〉0．05）。结论短时间持续静脉输注丙泊酚长链脂肪乳和丙泊酚中／长链脂肪乳均使儿童的甘油三酯和血清淀粉酶水平升高。与丙泊酚长链脂肪乳相比较，丙泊酚中／长链脂肪乳对血浆甘油三酯水平的影响更小，在术后的代谢更快，更适合应用于儿童短时间手术的麻醉。

Objective To compare the effect of propofol in long chain triglyceride（LCT） and propofol in medium and long chain triglyceride （ MCT - LCT） on hepatic function and serum triglyceride level in pediatric patients in general anesthesia. Methods A total of 60 children（ age 4 - 12, ASA I - Ⅱ ）, who underwent selective tonsillectomy and adenoidectomy were randomized into two groups of 30 each. Group A were induced and maintained with 1% LCT propofol （50ml/500mg） ,while Group B with 1% MCT -LCT propofol（20ml/ 200mg）. Blood samples for triglyceride （ TG）, alanine aminotransferase （ ALT）, aspartate aminotrasferase （ AST）, and amylase （AMY） were obtained before anesthesia induction To , at the end of operation T1 , and 4 hours after the end of surgery T2. Results AMY levels rose significantly above the basal levels in both Group A and Group B （P 〈 0.05 ）. TG levels rose above the basal levels at the end of operation T1 （ P 〈 0.05 ） and kept rising 4 hours after the end of surgery T2 （ P 〈 0. 05） in Group A. TG levels rose above the basal levels at the end of operation T1 （ P 〈 0.05 ） , while fell back to the basal levels 4 hours after the end of surgery T2 （ P 〉 0.05） in Group B. There was no statistical difference in ALT and AST value among three time points （ P 〉 0. 05 ）. Conclusion Even short - term anesthesia with LCT and MCT - LCT propofol （ 1% ） leads to elevated TG and AMY levels. The increase of TG levels in serum is less with MCT - LCT propofol and elimination of TG is also rapid after terminating MCT - LCT propofol infusion. The MCT - LCT propofol is more suitable for pediatric patients in shortterm anesthesia.