安氟醚和异氟醚对肝脏缺血/再灌注损害的影响

目的 研究安氟醚和异氟醚预处理对肝脏缺血／再灌注损害的影响。方法 １８只家兔随机分３组,对照组阻断肝劝脉和门静脉血流形成肝缺血４５ｍｉｎ,开放再灌注１２０ｍｉｎ;安氟醚和异氟醚预处理组,于缺血再灌注前分别吸入１．６８％安氟醚和１．１５％异氟醚２０ｍｉｎ和药物清除１０ｍｉｎ。结果 缺血前,三组血清谷丙转氨酶（ＡＬＴ）,谷草转氨酶（ＡＳＴ）、乳酸脱氢酶（ＬＤＨ）、碱性磷酸酶（ＡＬＰ）和谷氨酰酶（ＧＣＴ     

比较七氟醚、异氟醚和安氟醚对颅内压的影响

目的：为了观察七氟醚对颅内压的影响。方法：选择２４例颅内肿胶病人,测定七氟醚麻醉的时颅内压变化并与异氟醚和安氟醚进行比较。术前用药、麻醉诱导及维持的静脉用药相同。于Ｌ３－４穿刺蛛网膜睛腔测脑脊液压（代表颅内压,ＩＣＰ）。依吸入药不同随机分为七的氟醚（Ｓ）组,异氟醚（１）组和安氟醚（Ｅ）组,监测ＢＰ、ＭＡＰ、ＥＣＧ、ＳｐＯ２、ＰＥＴ、ＣＯ２和ＭＡＣ,调整ＶＴ和ＲＲａＣＯ２维持在４～４．６６ＫＰＡ。三     

异氟醚、安氟醚麻醉诱导期大鼠边缘系统部分核团一氧化氮合酶阳性神经元的改变

目的 观察异氟醚、安氟醚诱导麻醉对大鼠边缘系统部分核团一氧化氮合酶(NOS)阳性神经元的的改变,探讨异氟醚、安氟醚麻醉诱导期的作用机制。方法 18只SD雄性大鼠随机分为3组:对照组、安氟醚组、异氟醚组。对照组动物除不吸入麻醉气体外,其他条件均与两麻醉组相同。安氟醚组、异氟醚组大鼠分别吸入2％安氟醚或2％异氟醚至步态不稳、一侧肢体着地,即翻正反射即将消失时,移出麻醉箱,立即取标本。用NADPH-d组化法观察吸入2％异氟醚、2％安氟醚诱导麻醉对大鼠边缘系统部分核团NOS阳性神经元数量和灰度值的影响。结果 安氟醚组大鼠脑的外侧隔核、下丘脑室旁核、下丘脑室周核、视上核、杏仁基外侧核和伏隔核等6个核团NOS阳性神经元数量和染色深度均低于对照组,异氟醚组在上述6个核团中NOS阳性神经元的数量和平均灰度水平也低于对照组,下丘脑室周核和视上核NOS阳性神经元数目有减少趋势,但与对照组比较差异无统计学意义(P>0.05),其余核团与对照组比较差别均有显著性(P<0.01)。结论 异氟醚、安氟醚诱导期的作用机理可能与边缘系统部分核团NOS阳性神经元的改变有关。     

安氟醚与七氟醚复合氧化亚氮吸入诱导对心脏瓣膜手术病人血流动力学的影响

目的：观测安氟醚与七氟醚复合氧化亚氮吸入诱导及维持麻醉对心脏瓣膜手术病人血流动力学的影响。方法：４２例病人分两组,分别以安氟醚－氧化亚氮（Ⅰ组,ｎ＝２０）或七氟醚－氧化亚氮（Ⅱ组,ｎ＝２２）吸入诱导及维持麻醉。采用Ｓｗａｎ－Ｇａｎｚ导管技术监测血流动力学。结果：诱导后两组ＭＡＰ、ＣＩ、ＬＶＷＩ及ＬＶＳＷＩ有所减低（Ｐ〈０．０５）。气管插管后,两组的ＣＩ,ＳＩ及ＬＶＳＷＩ明显降低（Ｐ〈０．０５）,Ｈ     

异氟醚对大鼠脑3’5’-环腺苷酸含量的影响

目的 了解异氟醚对大鼠脑３’５’－环腺苷酸（ｃＡＭＰ）含量的影响。方法 ＳＤ大鼠４０只,随机分为五组,分别在未吸入异氟醚（对照组）,吸入１．４％异氟醚翻正反射消失时（翻正反射消失组）,吸入１．４％异氟醚平衡３０ｍｉｎ时（麻醉组）,吸入１．４％异氟醚平衡３０ｍｉｎ后将动物取出自制麻醉箱待翻正反射恢复时（恢复Ⅰ组）和吸入１．４％异氟醚平衡３０ｍｉｎ后将动物取出自制麻醉箱后３０ｍｉｎ时（恢复Ⅱ组）断头取     

常温及低温麻醉下安氟醚及异氟醚对心肌酶、氧自由基代谢及电解质的影响

目的 研究常温（37.5℃）及低温（30℃）麻醉下安氟醚及异氟醚对心肌酶、氧自由基代谢及电解质的影响。方法 健康家兔32只，离体Langendorff灌注，随机分为四组，每组8只。A组，常温1.3MAC安氟醚的K－H液灌液；B组，常温1.3MAC异氟醚的K－H液灌注；C组，低温1.3MAC安氟醚的K－H液灌注；D组，低温1.3MAC异氟醚的K－H液灌注。按不同组别要求测定冠状动脉流出液LDH、CK活性，心肌组织SOD、MDA及K^ 、Na^ 、Ca^2 、Mg^2 、Zn^2 含量。结果 A、B两组灌注前后LDH、CK无显著差异（P＞0.05），Zn^2 含量显著降低（P＜0.01），MDA明显降低（P＜0.05），Zn^2＋含量显著增高（P＜0.01）。四组心肌Ca^2 含量明显降低（P＜0.05或P＜0.01）。结论 临床常用麻醉强度的安氟醚及异氟醚对心肌细胞无直接损伤作用，但心肌Ca^2 、Zn^2 含量降低明显且安氟醚抑制心肌Ca^2 内流甚于异氟醚。低温下吸入安氟醚及异氟醚后能提高心肌抗氧化损伤能力，氧自由基产生减少。     

七氟醚全麻复合硬膜外阻滞在肝切除术中的应用

目的：观察两组行肝切除术患者肝门阻断前后血压脉搏变化以及术后肝功能变化情况。方法：２０例择期行肝部分切除术（均阻断肝门）的肝癌患者随机分为两组，Ａ组（复合组）１０例选用七氟醚全身麻醉复合硬膜外阻滞去，Ｂ组（对照组）１０例全凭撖这内吸入七氟醚全麻。结果：两组患者血压脉搏变化基本稳定，且两组间变化无明显差异；Ａ组患者在术后１周后肝功能恢复情况明显优于Ｂ组。结论：吸入七氟醚全身麻醉复合硬膜外阻滞是应用于     

七氟醚肝毒性研究的初步报告

为研究不同吸入浓度七氟醚对肝脏的影响，４０只ＳＤ大鼠被随机分为四组，对照组（Ｉ组，ｎ＝１０，０ＭＡＣ）；异氟醚组（Ⅱ组，ｎ＝１０，０．５ＭＡＣ）；０．５ＭＡＣ七氟醚组（Ⅲ，组，ｎ＝１０，０．５ＭＡＣ）；０．９ＭＡＣ七氟醚组（Ⅲ２组，ｎ＝１０，０．９ＭＡＣ）。各组动物分别吸相应浓度麻醉药，３ｈ／ｄ，共６ｄ，以肝功能变化，肝组织细胞这改变作为评价肝脏受损指标，结果提示，七氟醚对肝脏有一定的影响，与异氟     

国产和进口安氟醚临床应用的比较

目的：采用大样本随机双盲对照方法对国产和进口安氟醚临床应用进行比较。方法：心血管手术病人６０７例，随机分为国产安氟醚组（３０．７）和发氟醚组（３００例）。比较术后清醒时间、拔除气管插管时间、住ＩＣＵ和术后住院时间、术后心律失常发生率、术后神经系统并发症和肺部并发症和发生率以及术后死亡率。６０７例中随机抽出２０４例（国产组１０６例、进口组９８例）测定术后血清谷－丙转氨酶（ＧＰＴ）、血清尿素氮（ＢＵＮ     

七氟醚 异氟醚和安氟醚对离体兔胸主动脉环收缩功能的影响

目的：比较吸入麻醉药七氟醚、异氟醚和安氟醚对离体兔胸主动清脉环收缩功能的影响。方法：将取自２４只新西兰白兔的离体胸主动脉环随机分为七氟醚、异氟醚、安氟醚三组。衔用ＰＥ产生主动张力,稳定后分别吹入上述三种吸入麻醉药七氟醚记录不同浓度时的血管张力。结果：与基础值（麻醉药浓度为零时）相比,血管张力在三种吸入麻醉药２为１．０、１．５、２．０ＭＡＣ时均降低（Ｐ值分别小于０．０５、０．０５、０．０１）。安氟醚     

Serum enzymatic changes modulated using trypsin: chymotrypsin preparation during burn wounds in humans

The levels of marker enzymes for liver function, namely transaminases (SGPT, SGOT), creatine phosphokinase (CPK), alkaline phosphatase (ALP) and lactate dehydrogenase (LDH) were estimated in the sera of burn patients by administering trypsinchymotrypsin preparation and comparing with an untreated group. Neutrophil proteolytic activity was also measured by assaying the lysosomal enzymes, namely neutrophil clastase and cathepsin D. Our earlier studies have already proved the efficacy of the above enzyme preparation to burn patients on the enhancement of vascular responses during the acute phase of the burn injury. These beneficial responses were brought about by the modulation of acute phase proteins expressed in the liver. Hence, it is of interest to study the changes in the above mentioned liver enzymes and certain lysosomal enzymes in the serum during the first 10 days of burn injury. The levels of liver and lysosomal enzymes markedly decreased in the treated group when compared with the untreated group. The enzyme studies clearly indicated that the initial rise in the liver enzymes was minimized in the treated group when compared with the untreated group and this helped in reducing the stress to the liver in the treated cases. The increase in the activity of ₁-antitrypsin and ₂-macroglobulin and decreased levels of C-reactive protein are atributed to the reduction of proteolytic enzyme levels in the treated group and minimizing the degradative changes during wound repair.     

Complaints in the postoperative phase related to anesthetics

In two prospective, randomized studies the frequency of headache, nausea, vomiting, and analgesic requirement during the first postoperative 24 h was observed in order to study differences between the sexes and the inhalation anesthetics halothane, enflurane, isoflurane, or balanced anesthesia with enflurane/alfentanil. Nausea and vomiting were more frequent after enflurane than after halothane or isoflurane. There was no significant difference between anesthetics and frequency of headache, but there were significant differences in postoperative analgesic requirements which were highest after halothane and lowest after isoflurane. Postoperative complaints were always significantly greater among women than among men. The second study indicated that balanced anesthesia did not reduce the analgesic requirement compared to enflurane without alfentanil, but lead to a higher incidence of vomiting. After premedication with flunitrazepam and atropine and combined with 70% N2O/30% O2, isoflurane was the most favorable anesthetic agent with regard to the parameters studied. Balanced anesthesia with enflurane/alfentanil did not show any advantages for patients in the postoperative phase under the given conditions.     

Blunt hepatic injury and elevated hepatic enzymes: a clinical correlation in children

During a recent prospective nonrandomized comparison of noninvasive imaging techniques in 100 children with suspected major blunt abdominal injury, an interesting subset of patients was defined. Of 95 hemodynamically stable patients, 44 were found to have immediate elevation of hepatic enzymes (SGOT, SGPT greater than 30 IU). Nineteen of these children (43%) were subsequently shown to have significant liver injuries. No child with a liver injury had normal enzymes on admission. The level of enzyme elevation (SGOT chi 890 +/- 142 IU, SGPT chi 536 +/- 105 IU) in those with liver injuries is significantly greater than those without injury (SGOT chi 273 +/- 44 IU, SGPT chi 115 +/- 19 IU) (P less than or equal to 0.0001 SGOT. P less than or equal to 0.0001 SGPT). Our study has allowed definition of a group of children who are at significant risk for liver injury based on immediately available serum determinations of GOT and GPT. We have begun to use this information in our institution to select children for further noninvasive imaging. We recommend that these studies be obtained emergently in all children with suspected upper abdominal trauma.     

The role of elevated liver transaminase levels in children with blunt abdominal trauma

The role of serum glutamic oxaloacetic transaminase (SGOT) and serum glutamic pyruvic transaminase (SGPT) levels on intra-abdominal injury in children has not been adequately studied. In this report, the accuracy of these tests in predicting the degree and extend of intra-abdominal and hepatic injury in children with blunt abdominal trauma was investigated.Eighty-seven haemodynamically stable children with multiple trauma were prospectively evaluated. The SGOT and SGPT of patients with and without abdominal trauma (Groups I and II) were compared. Patients with and without radiologically verified intra-abdominal injury were further compared (Groups Ib and Ia).There was significant difference in SGOT and SGPT levels of Groups I and II. SGOT and SGPT levels were 333.6+/-283.8 and, 197.5+/-192.5 U/l, respectively in Group Ib; but 84.2+/-55.9, 43+/-29.8 U/l in Group Ia (P<0.001). In all patients with radiologically detected intra-abdominal pathology SGOT and SGPT levels were above 110.5 and 63.5 U/l, respectively. In patients with hepatic injury SGOT level was above 500 U/l and, SGPT level was above 300 U/l. Statistically significant positive correlation was found between radiologically detected intra-abdominal pathology and increased SGOT (above 110.5 U/l) and SGPT (above 63.5 U/l) levels (P<0.05).These data indicated that the SGOT and SGPT levels were significantly higher in patients with intra-abdominal injury even in the absence of hepatic injury. We suggest that liver function tests may be used as screening tests in children with blunt abdominal trauma in addition to physical abdominal examination. A sudden rise up to 110.5 U/l in SGOT and 63.5 U/l in SGPT indicate an intra-abdominal injury and severe hepatic injury should be suspected with higher levels of SGOT and SGPT.     

Effects of volatile anesthetics or fentanyl on hepatic function in cirrhotic rats

Halothane, enflurane, isoflurane, and fentanyl were examined for their potential to exacerbate liver dysfunction in rats with preexisting cirrhosis. Male Wistar rats given sodium phenobarbital for 2 weeks are assigned randomly to two groups. One group (cirrhotic) was exposed by inhalation to carbon tetrachloride (CCl4) in air at weekly intervals for 12 weeks to induce cirrhosis. The other group (noncirrhotic) was handled similarly but received air only. Five weeks after the last exposure to CCl4, cirrhotic and noncirrhotic rats were given three hours of 1 MAC halothane, enflurane, or isoflurane in 50% oxygen, or 350 micrograms fentanyl per kg of body weight and 50% oxygen, or 50% oxygen only. Blood gas tensions and blood glucose levels were measured before, during, and at the end of exposure. Forty-eight hours after exposure, serum chemistries were measured in each rat for comparison with preexposure values. Rats were then killed by CO2 overdose, and liver, kidney, and testis were prepared for microscopic examination. Enflurane, isoflurane, and halothane, but not fentanyl, produced mild respiratory acidosis and no change in serum glucose levels. All anesthetics resulted in a mild but similar degree of acute liver dysfunction as indicated by small increases in SGOT or SGPT in both cirrhotic and noncirrhotic rats. Liver histology revealed mild to moderate portal cirrhosis with fibrosis and well-developed micronodules in rats exposed to CCl4, but no superimposed acute hepatocellular damage was noted. It is concluded that all the anesthetics used in this study were associated with the same minimal degree of postanesthetic hepatic dysfunction and that the dysfunction was similar in both cirrhotic and noncirrhotic rats.     

Protective effects of PGE1 on postoperative liver function after gastric cancer surgery

The effects of PGE1 on liver function tests in patients who underwent gastric cancer surgery were studied. PGE1 was administered in 13 patients at a rate of 20-100 ng.kg-1.min-1 (PGE1 group) during surgery. Fourteen patients served as the control group. On the first postoperative day, SGOT and SGPT increased in both groups. But on the first and the third postoperative days, SGPT of the PGE1 group was significantly lower (P less than 0.05) than that of the control group. Five patients in the control group showed transaminase above 100 IU.l-1 in the postoperative period. In contrast, no patient showed this increase in the PGE1 group. These findings indicate that continuous infusion of PGE1 during surgery is beneficial in attenuating hepatic injury.     

Hepatotoxicity and metabolism of isoflurane in rats with cirrhosis

A rat model was used to determine whether isoflurane exacerbates liver dysfunction and whether its metabolism is changed in the presence of cirrhosis. Male Wistar rats were gavaged weekly with carbon tetrachloride until cirrhosis was well advanced. They and control rats without pretreatment with carbon tetrachloride and without cirrhosis were then exposed to 1.45% (1 MAC) isoflurane for 3 hours. Blood and urine samples were taken before, immediately, as well as 4, 24, 48, and 72 hours after anesthesia to measure liver function and isoflurane defluorination. After the last samples had been obtained, the rats were sacrificed and the liver removed for histologic examination and in vitro metabolic studies. Serum levels of SGOT and SGPT and inorganic fluoride production in rats with cirrhosis were similar to those in control rats without cirrhosis. Concentrations of cytochromes b5 and p-450 and specific activities of microsomal defluorinase and several cytosolic enzymes were significantly lower in cirrhotic than in noncirrhotic liver, but their total amounts in whole liver were the same. The results imply that cirrhosis does not increase the risk of acute hepatotoxicity of isoflurane. They also demonstrate that metabolism of isoflurane and perhaps other volatile anesthetics may be unaffected in rats with cirrhosis, even though liver architecture is severely disrupted.     

A comparison of liver function after hepatectomy in cirrhotic patients between sevoflurane and isoflurane in anesthesia with nitrous oxide and epidural block

In this study, we compared postoperative liver function in patients with liver cirrhosis between isoflurane and sevoflurane anesthesia with nitrous oxide (N(2)O) and epidural block. Forty cirrhotic patients with Child-Pugh Grade A, aged 40 to 70 yr, scheduled for liver segmentectomy, had anesthesia induced with midazolam 0.1 mg/kg and fentanyl 4 micro g/kg. For maintenance, intermittent epidural administration of 1.5% lidocaine 4 to 6 mL and sevoflurane (sevoflurane group) or isoflurane (isoflurane group) with N(2)O 3 L/min in oxygen 3 L/min was used. Aspartate aminotransferase, alanine aminotransferase, total bilirubin, alkaline phosphatase, choline esterase, albumin, prothrombin time, and platelet count were measured before and 1, 3, and 7 days after surgery. Aspartate aminotransferase, alanine aminotransferase, and alkaline phosphatase increased significantly, with the peaks at 3 days after surgery in both groups. The increases in these variables were significantly larger in the isoflurane group than those in the sevoflurane group. No patient developed hepatic failure. All increases in liver enzymes were small and of questionable clinical relevance. Whether sevoflurane might be a better anesthetic when combined with N(2)O and epidural block for cirrhotic patients than isoflurane with respect to liver damage remains to be determined. IMPLICATIONS: In cirrhotic patients with Child-Pugh Grade A, isoflurane induced more of an increase in serum concentrations of liver enzymes after surgery than sevoflurane when combined with nitrous oxide and epidural block. However, the increases were small, and there was no clinical liver damage.     

Clinical study on total intravenous anesthesia with droperidol, fentanyl and ketamine--8. Hepatic and renal functions following prolonged surgical operation of over 10 hours

Forty-four patients were studied to evaluate their postoperative hepatic and renal functions on 2nd to 4th and 7th to 10th postoperative days as judged by serum GOT, GPT, BUN and creatinine levels. The patients were divided into two groups. Twenty two patients received total intravenous anesthesia with droperidol, fentanyl and ketamine (FK group). The remaining 22 patients were given conventional enflurane-nitrous oxide anesthesia. The two groups were comparable concerning age, body weight, sex distribution, performed operation, operation time and anesthesia time. In the total intravenous group, fluid given and urine output were significantly larger than those of the enflurane group, and the amounts of blood loss and blood given tended to be greater but insignificantly in the total intravenous group than in the enflurane group. In both groups, postoperative S-GOT levels increased significantly and those of the enflurane group were significantly higher than those of the FK group on 2nd to 4th postoperative days. In the enflurane group, postoperative S-GPT levels were significantly higher, but those of the FK group were not. S-GPT on 2nd to 4th postoperative days of the enflurane group were significantly higher than those of the FK group. As to serum BUN and creatinine, no significant differences were observed between the two groups. These data suggest that FK is much more beneficial than enflurane anesthesia to protect hepatic functions, particularly when it is applied for prolonged surgical procedures.