丙泊酚和地氟烷对活体肝移植术患儿心肌保护效果的比较  

Comparison of myocardial protection in pediatric patients undergoing living-donor liver transplantation performed under propofol-versus desflurane-based anesthesia

作　　者：智嘉浩 曹艺美 曹颖莉 任恒昌[3] 贾莉莉[3] 翁亦齐[3] 杜洪印[3] 喻文立[3] Zhi Jiahao;Cao Yimei;Cao Yingli;Ren Hengchang;Jia Lili;Weng Yiqi;Du Hongyin;Yu Wenli(First Central Clinical College of Tianjin Medical University,Tianjin 300070,China;School of Medical,Nankai University,Tianjin 300071,China;Department of Anesthesiology,Tianjin First Center Hospital,Tianjin 300192,China)

机构地区：[1]天津医科大学一中心临床学院,天津300070 [2]南开大学医学院,天津300071 [3]天津市第一中心医院麻醉科,天津300192

出　　处：《中华麻醉学杂志》2023年第3期265-268,共4页Chinese Journal of Anesthesiology

基　　金：国家自然科学基金面上项目(82072219);天津市自然科学基金面上项目(21JCYBJC00160);天津市医学重点学科(专科)建设项目;天津市卫生健康委员会科技项目(ZC20233);天津市卫生健康委员会科技项目(ZC20052)。

摘　　要：目的比较丙泊酚和地氟烷对活体肝移植术患儿的心肌保护效果。方法选取全身麻醉下行活体肝移植术患儿60例,采用随机数字表法分为2组(n=30):丙泊酚组(P组)和地氟烷组(D组)。麻醉维持期间P组静脉输注丙泊酚5~10 mg·kg^(-1)·min^(-1),D组吸入地氟烷0.65 MAC~1.30 MAC。于麻醉诱导后5 min、再灌注1 h、术毕、术后1、2、3、7和14 d及出院当天,采用ELISA法测定血清高敏肌钙蛋白I(hs-cTnI)、肌酸激酶同工酶(CK-MB)、N末端脑B型利钠肽前体(NT-proBNP)浓度,记录术后24 h内恶心呕吐、躁动和寒战的发生情况、术后气管拔管时间、ICU停留时间和术后住院时间。结果与P组比较,D组术后血清hs-cTnI和CK-MB浓度降低,气管拔管时间和ICU住院时间缩短(P<0.05),各时点血清NT-proBNP浓度、术后住院时间和术后不良反应发生率差异无统计学意义(P>0.05)。结论地氟烷对活体肝移植术患儿的心肌保护效果优于丙泊酚,有利于早期预后。Objective To compare the myocardial protection in pediatric patients undergoing living-donor liver transplantation(LDLT)performed under propofol-versus desflurane-based anesthesia.Methods Sixty American Society of Anesthesiologists Physical Status classificationⅢorⅣpediatric patients of both sexes,aged 5-24 months,weighing 5-15 kg,scheduled for elective LDLT under general anesthesia,were divided into 2 groups(n=30 each)using a random number table method:propofol group(group P)and desflurane anesthesia group(group D).During anesthesia maintenance,propofol 5-10 mg·kg^(-1)·min^(-1) was intravenously infused in group P,desflurane 0.65 MAC-1.30 MAC was inhaled in group D.At 5 min after induction of anesthesia,at 1 h of reperfusion,at the end of surgery,at 1,2,3,7 and 14 days after surgery,and on the day of discharge,the concentrations of serum high-sensitivity cardiac troponin I,creatine kinase isoenzyme,N-terminal pro-B-type natriuretic peptide were determined by enzyme-linked immunosorbent assay,the occurrence of nausea and vomiting,agitation,and shivering,postoperative tracheal extubation time,intensive care unit stay time,and postoperative length of hospital stay were recorded within 24 h after surgery.Results Compared with group P,the concentrations of serum high-sensitivity cardiac troponin I and creatine kinase isoenzyme were significantly decreased after surgery,the extubation time and intensive care unit stay time were shortened(P<0.05),and no significant change was found in serum N-terminal pro-B-type natriuretic peptide concentrations,postoperative length of hospital stay and incidence of postoperative adverse effects at each time point in group D(P>0.05).Conclusions Desflurane has better myocardial protection than propofol in pediatric patients undergoing LDLT,which is helpful for early prognosis.

关 键 词：地氟烷 二异丙酚 肝移植 儿童 心肌损伤 

分 类 号：R726.5[医药卫生—儿科]