术中静脉输注不同剂量异丙酚对患者酸碱平衡及脂质代谢的影响

目的 评价术中静脉输注不同剂量异丙酚对患者酸碱平衡及脂质代谢的影响.方法 拟行广泛全子宫加盆腔淋巴结清扫术的宫颈癌患者60例,年龄30～64岁,体重40～75 kg,ASA Ⅰ或Ⅱ级,随机分为3组(n=20),Ⅰ组、Ⅱ组和Ⅲ组分别静脉输注异丙酚50、100、150μg·kg~(-1)·min~(-1).分别于麻醉诱导前即刻、开始静脉输注后1、2、3 h及术毕时行动脉血气分析,记录pH值、总二氧化碳(TCO_2)、碱剩余(BE)、HCO_3~-及乳酸(LA)浓度;取颈内静脉血样2 ml测定血清甘油三脂(TG)、总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDLL-C)、载脂蛋白A_1(APOA_1)及载脂蛋白B(APOB)的浓度.结果 3组各指标均在正常范围内.与麻醉诱导前即刻比较,静脉输注异丙酚后3组pH值、TC_2、BE、HCO_3~-及APOA_1浓度降低,LA及TG浓度升高,Ⅱ组及Ⅲ组LDL-C浓度降低,Ⅲ组APOB浓度降低(P<0.05或0.01);与Ⅰ组比较,静脉输注异丙酚后Ⅱ组及Ⅲ组pH值、BE、LDL-C及APOB浓度降低,TG浓度升高,Ⅲ组TCO_2、HCO_3~、TC及APOA_1浓度降低(P<0.05或0.01);与Ⅱ组比较,静脉输注异丙酚后Ⅲ组pH值、TCO_2、BE、TC及APOB浓度降低,TG浓度升高(P<0.05或0.01).结论 短时静脉输注异丙酚时患者酸碱平衡及脂质代谢均在正常范围,但有发生代谢性酸中毒及脂质代谢异常的趋势,且与剂量有关.

Effects of infusion of different doses of propofol during operation on acid-base balance and lipid metabolism

Objective To investigate the effects of infusion of different doses of propofol during operation on acid-base balance and lipid metabolism.Methods Sixty ASA Ⅰ or Ⅱ patients with cervical cancer, aged 30-64 yr, weighing 40-75 kg, scheduled for radical hysterectomy and pelvic lymph node dissection, were randomly divided into 3 groups ( n=20 each) : group Ⅰ, Ⅱ and Ⅲ received infusion of propofol at the rate of 50, 100 and 150μg·kg~(-1)·min~(-1) to maintain anesthesia, respectively. Blood samples were taken from radial artery immediately before anesthesia induction (T_1), at 1, 2 and 3 h after the start of propofol infusion (T_(2-4)) and at the end of operation (T_5) for blood gas analysis, and pH value, HCO_3~- , total carbon dioxide (TCO_2 ) , base excess (BE) and lactic acid ( LA) concentrations were recorded. Blood samples were taken from internal jugular vein for determination of serum concentrations of triglyeride (TG) , total cholesterol ( TC ) , high density lipoprotein cholesterol (HDL-C) , low density lipoprotein cholesterol (LDL-C) , apolipoprotein A_1( APOA_1) and apolipoprotein B (APOB) .Results All the parameters in the 3 groups were in the normal ranges. Compared with those at T_1, the pH value and concentrations of TCO_2, BE, HCO_3~- and APOA, were significantly decreased, while LA and TG concentrations were significantly increased after propofol infusion in all the groups, and LDL-C concentrations in group Ⅱ and IE and APOB concentration in group HI were significantly decreased after propofol infusion ( P < 0.05 or 0.01). Compared with group Ⅰ, the pH value and concentrations of BE, LDL-C and APOB were significantly decreased, while TG concentration was significantly increased after propofol infusion in group Ⅱ and Ⅲ , and concentrations of TCO_2, HCO_3~- , TC and APOA, were significantly decreased after propofol infusion in group Ⅲ(P<0.05 or 0.01). The pH value and concentrations of TCO_2, BE, TC and APOB were significantly lower, while TG concentration was significantly higher after propofol infusion in group Ⅲ than in group Ⅱ ( P < 0.05 or 0.01) . Conclusion When propofol is infused in a short time during operation, the acid-base balance and lipid metabolism are in the normal ranges,but metabolic acidosis and abnormal lipid metabolism may occur at the dase of 50,100 and 150μg·kg~(-1) ·min~(-1) .