七氟烷对腹腔镜肝部分切除术患者缺血再灌注指标的影响

Effects of Sevoflurane on Ischemia Reperfusion Indexes in Patients Undergoing Laparoscopic Partial Hepatectomy

目的探讨七氟烷运用于腹腔镜肝部分切除术患者麻醉中的效果。方法选取80例行腹腔镜肝部分切除术的患者为研究对象,采用随机数字表法分为观察组和对照组,各40例。2组均实施连续硬脊膜外阻滞复合全身麻醉,对照组予以异氟醚复合瑞芬太尼,观察组予以七氟烷复合瑞芬太尼维持麻醉,比较2组麻醉诱导前(T0)、手术开始时(T1)、手术开始30 min(T2)、手术结束即刻(T3)、拔管后10 min(T4)、术后1 d(T5)、术后3 d(T6)、术后7 d(T7)、不同时间点心率(HR)、平均动脉压(MAP);缺血再灌注指标[丙二醛(MDA)、超氧化物歧化酶(SOD)活性、血清血管内皮生长因子(VEGF)];肝肾功能指标[丙氨酸转氨酶(ALT)、肌酐(Cr)]及苏醒质量差异。结果观察组T1~T4HR水平分别为[(70.66±3.73)、(72.51±4.08)、(73.24±5.24)、(77.53±6.35)]次·min-1,高于对照组[(62.03±4.96)、(67.56±4.14)、(66.29±4.91)、(72.26±5.31)]次·min-1,差异均有统计学意义(P<0.05);观察组T3、T5、T6、T7时间点的SOD、VEGF分别为[(19.71±3.84)、(51.29±7.71)、(35.09±5.71)、(18.04±3.66)]U·mL^(-1)、[(448.26±21.21)、(438.52±28.08)、(449.36±26.33)、(442.73±30.28)]ng·L^(-1),依次高于对照组[(15.73±4.86)、(25.71±6.66)、(20.88±3.47)、(13.71±2.99)]U·mL^(-1)、[(440.18±24.29)、(431.19±26.03)、(440.56±25.08)、(434.75±26.71)]ng·L^(-1),差异均有统计学意义(P<0.05);MAD水平分别为[(6.61±3.40)、(12.99±5.13)、(8.77±3.18)、(5.71±1.33)]μmol·L^(-1),低于对照组[(8.81±2.54)、(20.85±4.65)、(15.24±2.80)、(8.51±2.36)]μmol·L^(-1),差异均有统计学意义(P<0.05);观察组患者睁眼时间、苏醒时间分别为(9.72±3.09)min、(13.97±2.37)min,短于对照组(11.15±3.24)min、(15.55±2.06)min,差异有统计学意义(P<0.05)。结论七氟烷运用于腹腔镜肝切除麻醉术中能够有效稳定患者血压,降低肝缺血再灌注损伤相关指标,对肾功能无明显影响,患者苏醒质量较佳。

Objective To explore the anesthesia effect of sevoflurane in patients undergoing laparoscopic partial hepatectomy.Methods Eighty patients undergoing laparoscopic partial hepatectomy were enrolled as the research objects.They were divided into observation group and control groupaccordingto random number table method,40 cases in each group.Both groups underwent continuous epidural block combined with general anesthesia.The control group was given isoflurane combined with remifentanil,while the observation group was given sevoflurane combined with remifentanil to maintain anesthesia.The heart rate(HR)and mean arterial pressure(MAP)at different time points[before anesthesia induction(T0),the beginning of the surgery(T1),after 30 min of the surgery(T2),immediately after surgery(T3),10 minutes after extubation(T4),1 d after surgery(T5),3 d after surgery(T6),7 d after surgery(T7)],the differences in ischemia reperfusion indexes[malondialdehyde(MDA),activity of superoxide dismutase(SOD),serum vascular endothelial growth factor(VEGF)],liver-kidney function indexes[alanine aminotransferase(ALT),creatinine(Cr)]and recovery quality were compared between the two groups.Results At T1-T4,HR levels in observation group were(70.66±3.73)times·min-1,(72.51±4.08)times·min-1,(73.24±5.24)times·min-1and(77.53±6.35)times·min-1,higher than those in control group[(62.03±4.96)times·min-1,(67.56±4.14)times·min-1,(66.29±4.91)times·min-1,(72.26±5.31)times·min-1],and the differences werestatistically significant(P<0.05).At T3,T5,T6 and T7,SOD and VEGF in observation group were[(19.71±3.84),(51.29±7.71),(35.09±5.71),(18.04±3.66)]U·mL^(-1) and[(448.26±21.21),(438.52±28.08),(449.36±26.33),(442.73±30.28)]ng·L^(-1),significantly higher than those in control group[(15.73±4.86),(25.71±6.66),(20.88±3.47),(13.71±2.99)]U·mL^(-1),[(440.18±24.29),(431.19±26.03),(440.56±25.08),(434.75±26.71)]ng·L^(-1),and the differences were statistically significant(P<0.05),while MAD levels in observation group were[(6.61±3.40),(12.99±5.13),(8.77±3.18)and(5.71±1.33)]μmol·L^(-1),significantly lower than those in control group[(8.81±2.54),(20.85±4.65),(15.24±2.80),(8.51±2.36)]μmol·L^(-1),and the differences were statistically significant(P<0.05).The eye-opening time and wake-up time in observation group were(9.72±3.09)min and(13.97±2.37)min,shorter than those in control group[(11.15±3.24)min,(15.55±2.06)min],and the differences were statistically significant(P<0.05).Conclusion The application of sevoflurane in the anesthesia of laparoscopic hepatectomy can effectively stabilize blood pressure of patients,and reduce the related indexes of hepatic ischemia-reperfusion injury,without significant effects on kidney functionand with good recovery quality.