异丙酚与安氟醚或七氟醚静吸复合麻醉对肝功能的影响

目的:观察异丙酚与安氟醚和七氟醚静吸复合麻醉对肝功能的影响.方法:32例择期非肝胆系统手术的全麻病人,随机分为4组,每组8例,分别给予安氟醚麻醉(A组)、七氟醚麻醉(B组)、异丙酚-安氟醚麻醉(C组)、异丙酚-七氟醚麻醉(D组).其中A、B组为对照组,C、D组为观察组.分别于麻醉前、麻醉诱导后2 h和术后3 d采集静脉血测血清丙氨酸转氨酶(ALT)、碱性磷酸酶(ALP)、白蛋白(ALB)、总胆红素(TBIL).结果:A组和B组在术后3 d ALT值高于麻醉前(P<0.01),但未超出正常值范围,二组间比较差异无显著性(P>0.05);4组患者在麻醉诱导后2 h ALB值低于麻醉前(P<0.05),但术后3 d各组的ALB值均恢复正常,而且各组间比较差异均无显著性(P>0.05);其余各项指标全程均无显著变化(P>0.05).结论:安氟醚和七氟醚两者均有潜在的、轻度的肝毒性;临床麻醉剂量的异丙酚能有效防止转氨酶的升高,对安氟醚及七氟醚所致肝脏损伤具有明显的保护作用;异丙酚复合安氟醚、七氟醚麻醉,是一种理想的静吸复合麻醉方法.

Effect of propofol-enflurane or propofol-sevoflurane combining anaesthesia on liver function

Objective:To investigate the effect of propofol enflurane or propofol sevoflurane combining anaesthesia on liver function. Methods:Thirty two adult patients,scheduled for selective non hepatic surgery under general anaesthesia,were randomly allocated to receiving enflurane fentanyl (Group A, n =8),sevoflurane fentanyl (Group B, n =8),propofol enflurane fentanyl (Group C, n =8) and propofol sevoflurane fentanyl (Group D, n =8) ,respectively,to maintain anaesthesia . Group A and Group B served as control groups. From the blood were taken specimens all thirty two patients, before aesthesia, 2 h after induction and 3 d after operation to measure the serum concentration of ALT, ALP, ALB and TBIL,repectively.Results: There was obvious increase in the serum concentration of ALT in group A and group B within normal reference range ( P <0 01). The serum concentration of ALB was obviously decreased 2 h after induction in all four groups ( P <0 05 ), but returned to normal 3 d after operation . There were no any significant difference among four groups, either ( P >0 05). There were no significant differences in other parameters. Conclusion:Both enflurane and sevoflurane have slight potential liver toxicity ;Propofol in clinical dose can obviously prevent the increase of aminotransferase activity and protect the liver from toxicity caused by enflurane and sevoflurane; combined propofol enflurane or propofol sevoflurane anaesthesia is a ideal general anaesthetic method.