七氟醚极低流量麻醉联合AmsorbPlus钙石灰对患者肝肾功能的影响  

Effects of minimal-flow sevoflurane anesthesia combined with Amsorb Plus calcium lime on hepatic and renal functions

作　　者：王钟兴[1] 黄婵燕[1] 张辉[1] 黄文起[1] 

机构地区：[1]中山大学附属第一医院麻醉科,广州市510089

出　　处：《中华麻醉学杂志》2012年第1期20-23,共4页Chinese Journal of Anesthesiology

基　　金：广东省科技厅科研基金（20078031302004）

摘　　要：目的评价七氟醚极低流量麻醉联合AmsorbPlus钙石灰对患者肝。肾功能的影响。方法择期拟行胃肠手术患者72例，ASA分级Ⅰ级或Ⅱ级，年龄20～60岁，采用随机数字表法，将患者随机分为2组（n=36）：中流量麻醉组（G1组）和极低流量麻醉组（G2组）。CO2吸收罐内放人AmsorbPlus钙石灰，监测并记录其中心温度。机械通气稳定后设定七氟醚挥发罐浓度4％，氧流量4L／min，呼气末七氟醚浓度达2．6％后，G1组设定氧流量为2L／rain，G2组设定氧流量为0．5L／min。术中氧流量不变，维持呼气末七氟醚浓度2．4％～2．8％。于术前24h、术后24h取血样，检测血清AST、AⅡ活性和总胆红素（TBIL）、直接胆红素（DBIL）、BUN和Cr的浓度，同时采集尿样，检测尿糖和尿蛋白浓度，记录尿糖阳性和尿蛋白阳性的发生情况。结果两组患者不同时点钙石灰中心温度比较差异无统计学意义（P〉0．05）。与术前24h时比较，术后24h时G，组血清AST活性、TBIL、DBIL浓度升高，BUN浓度降低（P〈0．05），Cr浓度、尿糖阳性率和尿蛋白阳性率比较差异无统计学意义（P〉0．05），G1组DBIL浓度升高，BUN浓度降低（P〈0．05），其余指标差异无统计学意义（P〉0．05）。两组肝肾功能各指标比较差异无统计学意义（P〉0．05）。结论七氟醚极低流量麻醉联合AmsorbPlus钙石灰对患者肝肾功能无明显影响，与中流量麻醉无差异，可安全地应用于临床。Objective To investigate the effects of minimal-flow sevoflurane anesthesia combined with a new CO2 adsorbent Amsorb Plus calcium lime on the hepatic and renal functions in patients. Methods Seventytow ASA Ⅰ or Ⅱ patients, aged 20-60 yr, scheduled for gastrointestinal surgery under general anesthesia, were randomized into 2 groups （n = 36 each） ： middle-flow anesthesia group （group GI ） and minimal-flow anesthesia group （group （;2）. Amsorb Plus calcium lime was added into the CO2 absorption canister and the core temperature of the calcium lime was continuously monitored and recorded. The patients were tracheal intubated after anesthesia induction and mechanically ventilated. The initial sevoflurane concentration was set at 4% and the fresh gas flow of oxygen was set at 4 L/min. After the end-tidal concentration of sevoflurane reached 2.6%, the fresh gas flow of oxygen was adjusted to 2 L/min in group GI or 0.5 L/rain in group （;2. The end-tidal concentration of sevoflurane was maintained at 2.4%-2.8% during operation. Venous blood samples were taken 24 h before and 24 h after op- eration for determination of the serum concentrations of total bilirubin （TBIL）, direct bilirubin （DBIL）, blood urea nitrogen （BUN） and creatinire （Cr） and activities of alanine aminotransferase （ALT） and aspartate aminotransferase （AST）. Urine samples were obtained at 24 h before and after operation to detect th6 concentration of glucose and protein. The urine glucose and protein positive patients were recorded. Results There was no significant dif- ference in the core temperature of calcium lime at different time points between the two groups （ P 〉 0.05）. Compared with that at 24 h before operation, AST activity, TBIL and DBIL concentrations were significantly increased, BUN concentration was significantly decreased, but no significant change was found in the Cr concentration and the number of urine glucose and protein positive patients at 24 h after operation in group GI, and DBIL co

关 键 词：麻醉药 吸入 麻醉 吸人 肝功能试验 肾功能试验 

分 类 号：R614[医药卫生—麻醉学]