七氟醚联合丙泊酚对肝硬化患者术后肝肾功能及免疫功能的影响

doi:10.12092/j.issn.1009-2501.2018.11.013

摘要/Abstract

摘要：

目的: 探讨七氟醚联合丙泊酚对肝硬化患者术后肝肾功能及免疫功能的影响。方法: 选取本院从2015年5月至2016年5月收治的72例肝硬化拟择期行脾切断流术患者，随机分为对照组36例和观察组36例，对照组麻醉维持给予丙泊酚，观察组麻醉维持采用七氟醚联合丙泊酚。比较麻醉前、麻醉诱导后2 h及术后1 d肝功能、肾功能、免疫功能、应激反应指标和麻醉效果。结果: 观察组患者的自主呼吸恢复时间、言语应答时间、定向力恢复时间、睁眼时间和拔管时间等均明显短于对照组(P＜0.01)。麻醉诱导2 h及术后1 d，观察组丙氨酸氨基转移酶(ALT)低于对照组、血清白蛋白（ALB）升高(P＜0.05)；观察组尿素氮（BUN）和肌酐（Cr）低于对照组(P＜0.05)；观察组CD4+和CD4+/CD8+明显高于对照组(P＜0.05)；对照组肾上腺素(NE)、去甲肾上腺素(NA)及皮质醇(COR)较麻醉前显著升高(P＜0.05)，观察组无明显变化(P＞0.05)，对照组在两个时间点均明显高于观察组［(241.43±22.15) ng/L vs. (196.74±18.47) ng/L，(230.86±20.28) ng/L vs. (191.13±17.59) ng/L; (352.38±29.47) ng/L vs. (247.84±21.23) ng/L，(341.65±27.87) ng/L vs. (241.64±20.52) ng/L; (253.13±25.95) ng/L vs. (131.37±15.53) ng/L,(231.91±19.97) ng/L vs. (128.93±15.15) ng/L］(P＜0.05)。结论: 七氟醚联合丙泊酚对肝硬化患者肝肾功能及免疫功能的影响相对轻，机制可能与减轻应激反应有关，适用于肝硬化患者。

关键词: 肝硬化, 肝功能, 肾功能, 免疫功能, 应激反应, 丙泊酚, 七氟醚

Abstract:

AIM: To explore the effects of propofol combined with sevoflurane on kidney function and immune function in patients with cirrhosis after splenectomy. METHODS: Seventy-two cases in our hospital from May 2015 to May 2016 were divided into two groups: control group (36 cases) and observation group (36 cases) according to random number table method. Control group received propofol anesthesia, while observation group received sevoflurane combined with propofol. Liver function, renal function, immune function, stress reaction and anesthetic effects of two groups were observed and compared at before anesthesia, 2 h after anesthesia induction and 1 d after surgery. RESULTS: The spontaneous breathing recovery time, speech response time, orientation recovery time, blink time and extubation time in observation group were significantly shorter than those of control group (P＜0.01). After induction of anesthesia for 2 hours and after operation for 1 day, the level of ALT of observation group was much lower than that of control group, and ALB was much higher than that of control group (P＜0.05). The levels of BUN and Cr in observation group was much lower than these in control group (P＜0.05). The levels of CD4+ and CD4+/CD8+ in observation group was much higher than those in control group (P＜0.05). The levels of NE, NA and COR in control group was significantly increased after anesthesia (P＜0.05), while no differences were found in observation group (P＞0.05). The levels of NE, NA and COR in control group were much higher than those in observation group at 2 h after anesthesia induction and 1 d after surgery (P＜0.05) ［(241.43±22.15) ng/L vs. (196.74±18.47) ng/L, (230.86±20.28) ng/L vs. (191.13±17.59) ng/L; (352.38±29.47) ng/L vs. (247.84±21.23) ng/L, (341.65±27.87) ng/L vs. (241.64±20.52) ng/L; (253.13±25.95) ng/L vs. (131.37±15.53) ng/L, (231.91±19.97) ng/L vs. (128.93±15.15) ng/L］. CONCLUSION: The effects of sevoflurane combined with propofol on liver function, renal function and immune function in patients with liver cirrhosis is relatively mild, and the mechanism may be related to the reduction of stress response. The combination therapy is suitable for patients with cirrhosis.

Key words: cirrhosis, liver function, renal function, immune function, stress reaction, propofol, sevoflurane

中图分类号:

R614.2

赵鹏程，张超. 七氟醚联合丙泊酚对肝硬化患者术后肝肾功能及免疫功能的影响[J]. 中国临床药理学与治疗学, 2018, 23(11): 1276-1281.

ZHAO Pengcheng, ZHANG Chao. Effects of propofol combined with sevoflurane on kidney function and immune function in patients with cirrhosis after splenectomy[J]. Chinese Journal of Clinical Pharmacology and Therapeutics, 2018, 23(11): 1276-1281.

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