肝功能障碍对七氟烷代谢产物游离六氟异丙醇的影响

Effects of liver dysfunction on the free hexafluoroisopropanol (HFIP) of sevoflurane metabolites

目的:观察七氟烷麻醉时其代谢产物游离六氟异丙醇(hexafluoroisopropanol,HFIP)的生成是否受肝功能状态的影响,以及其与麻醉恢复质量的关系。方法:选择肝功能正常(A组)与肝功能障碍CTPB级(Child-Turcotte-Pugh分级,B组)拟行择期腹部手术的患者,将两组完成研究方案并符合排除标准的各15例患者的统计结果行数据分析。麻醉诱导后分别吸入1.5MAC的七氟烷麻醉约3h。测定吸入七氟烷后0.5h、1h、2h、3h及停用七氟烷后0.5h、1h、2h、4h患者血液中的游离HFIP浓度。手术结束后观察记录患者苏醒时间(T1)、定向力恢复时间(T2)、指令响应时间(T3)、拔管时间(T4),并于拔管即刻、拔管后不同时点进行VAS疼痛及Ramsay镇静评分。结果:A、B两组患者血中游离HFIP浓度分别于七氟烷麻醉后1h和2h达峰值,停用七氟烷后两组游离HFIP浓度均逐渐降低。组间比较,除七氟烷麻醉后1h血中游离HFIP浓度B组低于A组(P<0.05)外,其余各对应时点无显著性差异。B组苏醒时间、指令响应时间、定向力恢复时间及拔管时间均大于A组(P<0.05);B组拔管后15min及30min的VAS疼痛评分均低于A组(P<0.05),拔管后30min、1h、2h的Ramsay镇静评分均高于A组(P<0.05)。结论:B级肝功对七氟烷代谢产物游离HFIP的生成无明显影响;在吸入相同浓度的七氟烷麻醉后,正常肝功与B级肝功患者麻醉恢复质量的差异可能与七氟烷代谢产物游离HFIP的影响关系不大。

Objective:To observe the effect of different liver function on the free hexafluoroisopropanol (HFIP) from the metabolism of sevoflurane,and evaluate the relationship between HFIP and the quality of anesthesia recovery.Methods:Patients undergoing elective abdominal surgery were divided into group A with normal liver function and group B with Child-Turcotte-Pugh Class B (CTP B) grade liver function.The statistical results of 15 patients in each group who completed the study program and met the exclusion criteria were analyzed.All patients were inhaled sevoflurane (1.5MAC) for anesthesia about 3 h.The free HFIP concentration was determined at the time points of 0.5 h,1 h,2 h,3 h after inhaled sevoflurane and 0.5 h,1 h,2 h,4 h after sevoflurane discontinued,respectively.The recovery conditions of patients,including anesthesia recovery time (T 1),orientation recovery time (T 2), command response time (T 3) and extubation time (T 4) were observed after operation.Also the Visual Analogue Scale (VAS ) and Ramsay sedation score were performed at different time points after extubation.Results:The time for free HFIP reaching its peak value in group A and group B was 1h and 2h after inhaled sevoflurane,respectively.Then the HFIP concentration gradually decreased after the given of sevoflurane was discontinued.Although the concentration of free HFIP in the group B at 1h after inhaled sevoflurane was lower than that of group A ( P <0.05),no significant differences were found between the two groups at corresponding time points.The anesthesia awake time,the orientation recovery time,the command response time and the extubation time in the group B were longer than those of group A ( P <0.05),respectively.The VAS pain scores in 15 min and 0.5 h after extubation in the group B were lower than those in the group A ( P <0.05).The Ramsay sedation scores at 0.5 h,1 h and 2 h after extubation in the group B were higher than those in the group A ( P <0.05).Conclusion:Liver function with grade B had no significant effects on free HFIP.The difference of anesthesia recovery quality between patients with normal liver function and grade B liver function may be little to do with the free HFIP after using the same concentration of sevoflurane for anesthesia.