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| 不同浓度七氟醚对肝脏清除功能和血流动力学的影响 |
| Effects of different concentrations of sevoflurane on the liver clearance and hemodynamics |
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| DOI：10.12089/jca.2020.03.012 |
| 中文关键词: 七氟醚 肝脏清除功能 血流动力学 脉搏染料光密度法 |
| 英文关键词: Sevoflurane Liver clearance Hemodynamics Pulse dye densitometry |
| 基金项目: |
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| 中文摘要: |
目的 采用脉搏染料光密度法评价不同浓度七氟醚麻醉对肝脏清除功能和血流动力学的影响。
方法 择期行妇科手术患者30例,年龄35～45岁,ASA Ⅰ 或 Ⅱ 级,随机分为0.6 MAC组、1.0 MAC组和1.4 MAC组,每组10例。采用潮气量法吸入七氟醚麻醉,分别维持0.6 MAC、1.0 MAC和1.4 MAC稳定15 min。分别在麻醉诱导前15 min和呼气末七氟醚浓度稳定后15 min进行吲哚菁绿(ICG)清除试验,测定ICG清除率(K)、15 min滞留率(R15) 、血浆半衰期(T1/2)、心排出量(CO)、心脏指数(CI)、每搏量(SV)和循环血容量(BV)、肝脏有效血流量(EHBF)、运氧量(DO2)和平均循环时间(MTT)。分析三组呼气末七氟醚浓度稳定后15 min时K与EHBF的相关性。
结果 与麻醉诱导前15 min比较,呼气末七氟醚浓度稳定后15 min时0.6 MAC组和1.4 MAC组BV明显升高(P<0.05),1.4 MAC组EHBF明显降低(P<0.05),三组K明显降低(P<0.05),R15明显升高(P<0.05),T1/2明显缩短(P<0.05)。三组K与EHBF在呼气末七氟醚浓度稳定后15 min具有明显线性正相关关系(P<0.05)。
结论 0.6～1.4 MAC七氟醚麻醉可降低肝脏的清除功能,不影响正常肝脏储备功能,在此范围内无剂量相关性;其血流动力学保持相对稳定。 |
| 英文摘要: |
Objective To investigate the effect of different concentrations of sevoflurane on the liver clearance and hemodynamics by pulse dye densitometry.
Methods Thirty patients undergoing elective gynecological surgery, aged 35-45 years, ASA physical status Ⅰor Ⅱ, were randomly assigned into three groups: group 0.6 MAC, group 1.0 MAC and group 1.4 MAC, 10 cases in each. Anesthesia was induced by a concentration of 8% sevoflurane and 100% oxygen via mask. After induction, the end-tidal sevoflurane concentration was maintained at 0.6 MAC, 1.0 MAC and 1.4 MAC for 15 min, respectively. Liver function was studied by pulse dye densitometry (PDD) with indocyanine green (ICG), which was injected 15 min before anesthesia and 15 min after anesthetic induction, then recorded the test Results : ICG clearance (K), retention rates at 15 min (R15), half-time of ICG in plasma (T1/2), cardiac output (CO), cardiac index (CI), strike volume (SV), blood volume (BV), effective hepatic blood flow (EHBF), transport volume of oxygen (DO2), and mean transport time (MTT). The correlation between K and EHBF was analyzed 15 minutes after the end-tidal sevoflurane concentration was stable.
Results Compared with 15 min before anesthesia BV in group 0.6 MAC and group 1.4 MAC increased prominently at 15 min after anesthesia (P < 0.05), and EHBF in group 1.4 MAC decreased significantly at 15 min after anesthesia (P < 0.05). Compared with 15 min before anesthesia K decreased significantly (P < 0.05), R15 increased significantly (P < 0.05), and T1/2 shortened significantly (P < 0.05) in the three groups at 15 min after anesthesia, but the difference between the groups was not statistically significant. There was a highly linear positive correlation between the three groups of K and EHBF at 15 min after anesthesia.
Conclusion Sevoflurane maintained at an end-tidal concentration between 0.6 MAC to 1.4 MAC can reduce liver clearance function without affecting reserve function of normal liver, and there is no dose correlation within this range. Besides, the hemodynamics remains relatively stable. |
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