摘要
目的 探讨七氟醚-瑞芬太尼或异丙酚-瑞芬太尼在右肝部分切除术中对肝脏缺血/再灌注损伤的影响。方法选取择期全麻下行右肝癌切除术并行全肝阻断患者80例。随机分为异丙酚维持组（P组）和七氟醚维持组（S组）各40例。P组麻醉维持采用靶控输注异丙酚和瑞芬太尼;S组则吸入七氟醚,靶控输注瑞芬太尼。比较两组血流动力学指标,麻醉诱导前（T0）、肝门开放后即刻（T1）、30分钟（T2）、6小时（T3）、术后1天（T4）、术后3天（T5）、术后5天（T6）,血清中白细胞介素（IL-1）、肿瘤坏死因子（TNF-α）、谷丙转氨酶（ALT）、谷草转氨酶（AST）。结果 两组各时点MAP、HR、CVP及术中出血量的比较,差异无统计学意义（P〉0.05）。S组T3~T5时间点ALT、AST、TNF-α、IL-1高于P组,差异有统计学意义（P〈0.05）。结论异丙酚复合瑞芬太尼可能通过减少TNF-和IL-1的产生来减轻炎症反应,减轻肝缺血再灌注损伤程度优于七氟醚复合瑞芬太尼。
Objective To investigate the effect of sevoflurane-remifentanil or propofol-remifentanil on hepatic ischemia/reperfusion injury in the right hepatic tumor resection. Methods Eighty patients with right liver cancer resection under general anesthesia were randomly divided into propofol group （group P） and sevoflurane group （S group） ,40 in each group. The group P was maintained anesthesia with target controlled infusion of propofol and fentanyl while S group was inhaled sevoflurane with target controlled infusion of fentanyl. The hemodynamic indexes and serum interleukin prime （IL-1）, tumor necrosis factor （TNF-α）, alanine aminotransferase （ALT） and aspartate aminotransferase （AST） at time points of 5 days before induction of anesthesia （T0）, immediate （T1） ,30 min （T2） and 6 hours （T3） after haptie vascular release,1 day （T4） ,3 days （TS） and 5 days after surgery （T6） were compared between the two groups. Results There was no significant difference in MAP, HR, CVP and the amount of bleeding during operation at each time point between the two groups （P 〉 0. 05）. The levels of ALT,AST,TNF-α and IL-1 at the T3 - T5 time points were higher in the group S than that in the group P（P 〈 0. 05）. Conclusion Propofol and remifentanil may alleviate the hepatic ischemia reperfusion in- jury than sevoflurane and remifentanil. The mechanism may be through reduction of the generation of TNF-α and IL-1 to relieve inflammation.
出处
《实用医院临床杂志》
2016年第5期150-152,共3页
Practical Journal of Clinical Medicine
