不同麻醉方法对活体肝移植患者血流动力学、脑氧代谢和致痛物质的影响  

Effects of Different Anesthesia Methods on Hemodynamics,Cerebral Oxygen Metabolism and Pain-causing Substances in Living Donor Liver Transplantation Patients

作　　者：李超 朱洪宽 陈永伦[1] LI Chao;ZHU Hong-kuan;CHEN Yong-lun(Department of Anesthesiology,Qujing First People's Hospital,Qujing Yunnan 655000)

机构地区：[1]云南省曲靖市第一人民医院麻醉科,云南曲靖655000

出　　处：《医学临床研究》2023年第1期10-13,共4页Journal of Clinical Research

摘　　要：[目的]探讨不同麻醉方法对活体肝移植(LDLT)患者血流动力学、脑氧代谢和致痛物质的影响.[方法]本院收治的LDLT患者112例,随机分为七氟醚组(采用七氟醚复合麻醉)和异氟醚组(采用异氟醚复合麻醉),每组56例.比较两组患者术前、无肝前期、无肝期35 min、新肝期30 min、新肝期2 h、新肝期12 h时血流动力学指标[心率(HR)和平均动脉血压(MAP)]和脑氧代谢指标[脑氧摄取率(CO_(2)ER)和颈内静脉球血氧饱和度(SjvO_(2))]变化情况,分析两组患者术后12 h、24 h致痛物质[血清P物质(SP)和5-羟色胺(5-HT)]变化情况,记录两组患者围术期不良反应发生情况.[结果]术前及新肝期12 h,七氟醚组与异氟醚组患者HR、MAP、CO_(2)ER、SjvO_(2)比较,差异无统计学意义(P>0.05);无肝前期至新肝期2 h,七氟醚组患者HR和SjvO_(2)低于异氟醚组(P<0.05),MAP和CO_(2)ER高于异氟醚组(P<0.05).术后24 h,七氟醚组与异氟醚组患者血清SP、5-HT水平均高于术后12 h(P<0.05);七氟醚组患者术后12 h、24 h血清SP、5-HT水平均低于异氟醚组(P<0.05).两组患者围术期不良反应发生率比较,差异无统计学意义(P>0.05).[结论]相较于异氟醚复合麻醉,七氟醚复合麻醉对LDL T患者围术期血流动力学和脑氧代谢的影响均较小,可明显抑制患者术后致痛物质水平,且安全性较高,值得临床推广应用.【Objective】To analyze the effects of different anesthesia methods on hemodynamics,cerebral oxygen metabolism and pain-causing substances in living donor liver transplantation(LDLT)patients.【Methods】A total of 112 LDLT patients admitted to our hospital were selected in this study.According to the random number table method,patients were divided into the sevoflurane group(anesthesia with sevoflurane,n=56)and the isoflurane group(anesthesia with isoflurane,n=56).The changes of hemodynamic indexes[heart rate(HR)and mean arterial pressure(MAP)]and cerebral oxygen extraction rate(CO_(2)ER)and jugular venous blood oxygen saturation(SjvO_(2))were compared between the two groups before operation,before anhepatic phase,35 min in anhepatic phase,30 min in neohepatic phase,2 h in neohepatic phase,and 12 h in neohepatic phase.Changes of pain-causing substances[substance P(SP)and 5-hydroxytryptamine(5-HT)in serum]at 12 h and 24 h after surgery in the two groups of patients were compared between the two groups as well.The adverse reactions of the two groups of patients in the perioperative period were recorded.【Results】There were no significant differences in HR,MAP,CO_(2)ER and SjvO_(2) between the sevoflurane group and the isoflurane group before surgery and 12 h in neohepatic phase(P>0.05).From pre-anhepatic phase to 2 h in neohepatic phase,HR and SjvO_(2) in the sevoflurane group were lower than those in the isoflurane group(P<0.05),and MAP and CO_(2)ER in the sevoflurane group were higher than those in the isoflurane group(P<0.05).At 24 h after surgery,serum SP and 5-HT levels in both sevoflurane group and isoflurane group were higher than those in both groups at 12 h after surgery(P<0.05).Serum SP and 5-HT levels in the sevoflurane group were lower than those in the isoflurane group at 12 h and 24 h after surgery(P<0.05).There was no significant difference in the incidence of perioperative adverse reactions between two groups(P>0.05).【Conclusion】Compared to the way of anesthesia with isoflurane,method of a

关 键 词：肝移植/外科学 麻醉 血流动力学 脑/代谢 氧/代谢 

分 类 号：R657.3[医药卫生—外科学]