丙泊酚复合七氟醚麻醉对肝功能不全患者术后肝肾功能的影响

Effects of propofol combined with sevoflurane anesthesia on liver and renal function in patients with liver dysfunction after operation

目的观察丙泊酚复合七氟醚麻醉对肝功能不全患者术后肝肾功能的影响。方法将因肝炎、肝硬化而实施脾切断流术的患者62例,根据随机数字表法分为七氟醚组32例和复合麻醉组30例。分别于术前、麻醉诱导后2 h及术后1 d对2组患者的肝功能、肾功能及自由基水平进行监测。结果七氟醚组丙氨酸氨基转移酶(ALT)、白蛋白(ALB)不同时间点比较差异显著(P<0.05),碱性磷酸酶(ALP)、总胆红素(TBIL)不同时间点比较差异无统计学意义(P>0.05);复合麻醉组ALT、ALB、ALP和TBIL在不同时间点比较差异均无统计学意义(P>0.05)。麻醉前,2组患者尿素氮(BUN)水平、肌酐(Cr)水平差异无统计学意义(P>0.05);麻醉诱导后2 h、术后1 d,复合麻醉组BUN、Cr水平均显著低于七氟醚组(P<0.05)。七氟醚组不同时间点超氧化物歧化酶(SOD)、丙二醛(MDA)水平差异显著(P<0.05);复合麻醉组不同时间点SOD、MDA水平差异无统计学意义(P>0.05)。结论丙泊酚复合七氟醚麻醉对肝功能不全患者术后肝肾功能的影响较小,值得临床推广应用。

Objective To study the effect of propofol combined with sevoflurane anesthesia on liver and renal function in patients with liver dysfunction after operation. Methods 62 patients who underwent splenic resection due to hepatitis and cirrhosis,according to the random number table,were divided into sevoflurane group（ 32 cases） and compound anesthesia group（ 30 cases）. The liver function,renal function and free radical level of two groups were monitored before and after 2 h of anesthesia induction and 1 d after operation,respectively. Results The levels of alanine aminotransferase（ ALT） and albumin（ ALB） in sevoflurane group at different time points were significantly different（ P〈0. 05）,There was no significant difference in the levels of alkaline phosphatase（ ALP） and total bilirubin（ TBIL） in sevoflurane group at different time points（ P〉0. 05）; There was no significant difference in ALT,ALB,ALP and TBIL in compound anesthesia group at different time points（ P〉0. 05）. There was no significant difference in the level of urea nitrogen（ BUN） and creatinine（ Cr） between two groups before anesthesia（ P〉0. 05）. The levels of BUN and Cr in compound anesthesia group were significantly lower than those in sevoflurane group（ P〈0. 05） at 2 h after anesthesia and 1 d after operation. The levels of superoxide dismutase（ SOD） and malondialdehyde（ MDA） in sevoflurane group at different time points were significantly different（ P〈0. 05）. There was no significant difference in SOD and MDA levels in anesthesia groups at different time points（ P〉0. 05）. Conclusion Combined anesthesia of propofol and sevoflurane has little effect on liver function and kidney function,and it can be applied in clinical.