硬膜外阻滞复合异氟烷吸入对肝脏缺血再灌注损伤的影响

目的: 观察硬膜外阻滞复合异氟烷吸入对肝脏缺血再灌注损伤的影响,为肝癌手术麻醉选择合理的麻醉方法。方法: 36例肝癌手术患者随机分为硬膜外阻滞联合全麻组(E组,n=18)和全麻组(G组,n=18).E组患者选择T8~9间隙行硬膜外穿刺置入硬膜外导管(F₃).两组诱导方法一致,静脉滴注咪达唑仑、芬太尼、丙泊酚及维库溴铵气管插管.记录麻醉前、插管后、手术切皮、肝门阻断、肝门开放、拔管后即刻的收缩压(SBP)、舒张压(DBP)、HR、IL-6水平及肝功能的变化。结果: E组硬膜外注入局麻药后,各项血液动力学参数虽有所变化,但与基础值比较差异均无显著性(P>0.05);气管插管后和拔管后即刻G组SBP、DBP增加,与E组比较差异均有显著性(P<0.05~P<0.01);插管后至术毕G组血清IL-6水平升高与E组比较差异均有显著性(P<0.05~P<0.01).两组丙氨酸氨基转移酶、谷草转氨酶指标再灌注后均较缺血前升高(P<0.01)。结论: 硬膜外阻滞复合异氟烷吸入,可减轻手术应激反应,对肝脏缺血再灌注损伤有一定的保护作用。

Influence of epidural anesthesia combined with isoflurane on hepatic ischemia-reperfusion injury

Objective:To determine if epidural anesthesia combined with isoflurane has protective effect on hepatic ischemia-reperfusion injury.Methods:Thirty-six patients with hepatocellular carcinoma were randomized to epidural anesthesia combined with isoflurane group(group E,n=18) and general anesthesia group(group G,n=18).Continuous epidural anesthesia(CEA) was performed at T (8-9) with F 3 in group E.In both groups,anesthesia was induced with midazolam,fentanyl,propofol and vecuronium.The SBP,DBP,HR,IL-6 level and the changes of liver function were measured respectively before anesthesia,after tracheal intubation,pringle maneuver,open pringle maneuver and at the end of operation.Results: The hemodynamic changes were not significant in group E(P<0.05 to P<0.01);Serum IL-6 concentrations increased significantly the moment after tracheal intubation and at the end of operation in group G,compared to those in group E(P<0.05 to P<0.01).The activities of serum aspartate transaminase(AST),alanine transaminase(ALT) increased markedly after reperfusion,compared with those before ischemia in the two groups(P<0.01).Conclusions:Epidural anesthesia combined with isoflurane can reduce the stress response and produce protective effects on the hepatic ischemia-reperfusion injury to some extent.