丙泊酚注射对苯妥英钠用药下行开颅术患儿肝胰功能及酸碱平衡的影响  

作　　者：Hatice Ture, MD Arzu Mercan, MD , Ozge Koner, MD Bora Aykac, MD Ugur Tare, MD 王琦(译) 李文志(校) 

机构地区：[1]Departments of Anesthesioloty and Reanimation, [2]Departments of tNeurosurgery, Yeditepe University School of Medicine, Istanbul, Turkey [3]不详

出　　处：《麻醉与镇痛》2012年第3期62-67,共6页Anesthesia & Analgesia

摘　　要：背景在此项研究中，我们评估了应用苯妥英钠预防癫痫的患儿行开颅手术中输注丙泊酚对其肝、胰酶和酸碱平衡的影响。方法在这项前瞻性的临床研究中，我们测定了30例4—12岁患儿的血清谷草转氨酶（AST）、谷丙转氨酶（ALT）、γ-谷氨酰转肽酶（GGT）、碱性磷酸酶（ALP）、胰淀粉酶、胰脂肪酶及三酰甘油水平。患儿接受丙泊酚麻醉并应用苯妥英钠预防癫痫。以前已用苯妥英钠的患儿则继续用药。未曾用药者口服苯妥英钠5mg·kg^-1·d^-1。经医院批准于术前1天，术后第1、3、5、7天测定患儿血清中AST、ALT、GGT、ALP、胆红素、胰淀粉酶、胰脂肪酶、三酰甘油水平。分别于气管插管后、术中2小时和术中4小时、拔管以及拔管后1、2、6、12小时采集动脉血气样本。结果术后血清AST、ALT、GGT、ALP、胰淀粉酶、胰脂肪酶、三酰甘油水平显著高于术前基础值，且于术后第1天达峰值，并在1周内恢复正常。拔管后碱剩余与基础值相比显著降低，但仍在正常范围内，并于术后6小时恢复到基础值水平。患儿并未表现出肝炎或胰腺炎的临床症状或体征。胆红素水平正常。患儿在术后4—6个月内未发生肝胰相关的并发症。结论尽管开颅术患儿肝、胰酶在术后轻微上升，但丙泊酚全麻维持未对其酸碱平衡或肝、胰酶产生临床意义的显著影响。BACI（GROUND： In this study, we investigated the effects of propofol infusion on hepatic and pancreatic enzymes and acid-base status compared with baseline values in children undergoing craniotomy who were receiving phenytoin for antiepileptic prophylaxis. METHODS： In this prospective clinical study, we measured the serum aspartate aminotransferase （AST）, alanine anlinotransferase （ALT）, γ-glutamyl transpeptidase （GGT）, alkaline phosphatase （ALP）, pancreatic amylase, lipase, and triglyceride levels of 30 children ranging from 4 to 12 yr. All children received propofol anesthesia and were taking phenytoin for antiepileptic prophylaxis. Patients already receiving phenytoin were continued on their medication. Peroral 5 mg·kg^-1·d^-1 phenytoin was started in patients who were not receiving phenytoin. Serum AST, ALT, GGT, ALP, bilirubin, pancreatic amylase, lipase, and triglyceride levels were studied on admission to the hospital, 1 day before surgery, and on postoperative Days 1,3, 5, and 7. Arterial blood gas samplings were taken after tracheal intubation, during the operation （2nd and 4th h）, iust after extubation, and 1,2, 6, and 12 h after extubation. RESULTS： Serum AST, ALT, GGT, ALP, pancreatic amylase, lipase, and triglyceride levels were increased significantly in the postoperative period compared with baseline with a peak value on postoperative Day 1 and returned to normal values within a week. Base excess levels after extubation were significantly decreased compared with baseline. They were in the normal range, however, and returned to baseline values by 6 h after surgery. There were no clinical signs of hepatitis or pancreatitis. Bilirubin levels were normal. None of the children developed complications related to the liver or pancreas during the 4 -6 mo after surgery. CONCLUSIONS： Despite the slightly increased pancreatic and hepatic enzyme levels during the postoperative period, anesthesia maintenance with propofol in children undergoing craniotomy had no significant clini

关 键 词：口服苯妥英钠 酸碱平衡 开颅术 患儿 肝炎 用药 血清谷草转氨酶 胰功能 

分 类 号：R758.25[医药卫生—皮肤病学与性病学]