不同肝功能Child-Pugh分级全身麻醉患者丙泊酚诱导及麻醉效果  

Induction and Anaesthesia Effect of Propofol in General Anesthesia Patients with Different Liver Function Based on Child-Pugh Grading

作　　者：周萍[1] 周伟[1] 张强[1] ZHOU Ping;ZHOU Wei;ZHANG Qiang(Department of Surgical Anesthesiology, Puyang Oilfield General Hospital of Henan Province, Puyang 457001, China)

机构地区：[1]河南省濮阳市油田总医院手术麻醉科,濮阳457001

出　　处：《医药导报》2019年第1期66-70,共5页Herald of Medicine

摘　　要：目的探讨不同肝功能Child-Pugh分级在全身麻醉患者使用丙泊酚诱导的临床意义。方法肝硬化择期腹部手术患者126例,按Child-Pugh肝功能A、B、C级对应分为A、B、C组,每组各42例;另选取42例肝功能正常择期腹部手术患者为对照组。4组患者均采取丙泊酚靶控输注麻醉进行诱导。比较4组患者达到同等镇静效果[警觉镇静(OAA/S)评分≤1分]时,肝代谢指标[丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)、白蛋白(ALB)、总胆红素(T-BiL)、凝血酶原时间(PT)],血流动力学指标[收缩压(SBP)、舒张压(DBP)、平均动脉压(MAP)、心率(HR)],动脉血气监测指标[动脉血氧饱和度(Sa O2)、动脉血氧分压(PaO2)、动脉血二氧化碳分压(PaCO2)],脑电双频谱指数(BIS)及丙泊酚效应室浓度。结果对照组、A组、B组、C组ALB含量依次呈递减趋势,T-BiL、PT含量总体上呈显著增加趋势(P<0.05)。4组患者OAA/S评分≤1分时SBP、DBP、MAP、BIS均显著低于基础值(P<0.05)。对照组、A组、B组、C组的SBP、DBP、MAP及丙泊酚效应室浓度均呈显著降低趋势(P<0.05)。B组、C组低血压发生率显著高于对照组(P<0.05)。A组、B组心动过缓及心律失常发生率显著高于C组(P<0.05)。结论评估患者肝功能Child-Pugh的分级程度,有利于精准把握手术中丙泊酚的用量,降低不良事件的发生,从而提高手术安全性,改善预后。Objective To investigate the clinical significance of Child-Pugh grading of liver function in patients with general anesthesia induced by propofol induction.Methods The126patients with liver cirrhosis undergoing elective abdominal surgery were divided into group A,B,C,which meet the standard of Child-Pugh A,B,C grade respectively according to the classification of Child-Pugh liver function,with42patients in each.In addition,42patients with normal liver function and elective abdominal surgery were selected as the control group.All patients with general anesthesia were induced by propofol target controlled infusion anesthesia.When reaching the same sedative effect[alert sedation(OAA/S)score≤1],the indexes of liver metabolism[alanine aminotransferase(ALT)and aspartate aminotransferase(AST),albumin(ALB),total bilirubin(T-BiL),prothrombin time(PT)],hemodynamics[systolic blood pressure(SBP),diastolic blood pressure(DBP),mean arterial pressure(MAP),heart rate(HR)],arterial blood gas monitoring[arterial oxygen saturation(SaO2),arterial oxygen pressure(PaO2),arterial carbon dioxide pressure(PaCO2)],BIS and propofol concentration in four groups were compared.Results The content of ALB in the control group,group A,B and C tended to decreased,and the content of T-BiL,PT showed an increasing trend(P<0.05).When the OAA/S score was less than1points,four groups of SBP,DBP,MAP,BIS were below baseline(P<0.05).In all the groups,group A,B and C,the SBP,DBP,MAP and effect-site concentration of propofol,tended to decrease(P<0.05).The incidence of hypotension in group B and C was significantly higher than that in control group(P<0.05).The incidence of bradycardia and myocardial ischemia in group A and B was significantly higher than that in group C(P<0.05).Conclusion It is beneficial to control the dosage of propofol,reduce the adverse event,and improve surgical safety and prognosis in patients with general anesthesia by evaluating the liver function using Child-Pugh grading.

关 键 词：丙泊酚 肝硬化 CHILD-PUGH分级 麻醉 全身 

分 类 号：R971[医药卫生—药品] R657.31[医药卫生—药学]