七氟醚与丙泊酚用于麻醉维持对肝移植术患者肾功能及术后认知影响的比较  

Effects of sevoflurane or propofol anesthesia maintenance on renal function and postoperative cognition in patients undergoing liver transplantation

作　　者：徐进辉 袁买龙 周涛[1] 张明生[1] 李亚琦[1] XU Jinhui;YUAN Mailong;ZHOU Tao;ZHANG Mingsheng;LI Yaqi(Department of Anesthesiology,Jiangxi Provincial People′s Hospital(The First Affiliated Hospital of Nanchang Medical College),Nanchang 330006,Jiangxi,China)

机构地区：[1]江西省人民医院(南昌医学院第一附属医院)麻醉科,江西南昌330006

出　　处：《实用医学杂志》2024年第24期3509-3514,共6页The Journal of Practical Medicine

基　　金：江西省卫生健康委科技计划一般项目(编号:202210152)。

摘　　要：目的通过对比研究七氟醚或丙泊酚麻醉维持在肝移植患者中的应用,探讨其对患者肾功能及术后认知的影响及可能机制。方法选择江西省人民医院拟行原位肝移植术患者60例,年龄18~60周岁;ASAⅡ-Ⅲ级。根据维持方案的不同随机分成两组(n=30):P组(丙泊酚组)、S组(七氟醚组)。麻醉维持:P组术中持续靶控输注丙泊酚复合盐酸瑞芬太尼注射液;S组术中七氟醚吸入复合输注盐酸瑞芬太尼注射液。分别于麻醉诱导前(T0)、切皮即刻(T1)、无肝期30 min(T2)、新肝期3 h(T3)、术后12 h(T4)、术后24 h(T5)、术后72 h(T6)共7个时间点记录两组患者平均动脉压(MAP)、心率(HR)、中心静脉压(CVP),各抽取中心静脉血3 mL,采用ELISA法检测上述时点血清中性粒细胞明胶酶相关脂质运载蛋白(NGAL)、血清胱抑素C(Cys C)、肾损伤分子1(KIM-1);多配体蛋白聚糖1(SDC-1)、硫酸肝素(HS)、透明质酸(HA);炎性标志物(TNF-α、IL-6)血清浓度水平;于T0、T5、T6时点采用简易智能精神状态检查量表(MMSE)进行认知功能评估并统计认知功能障碍(MMSE<23分)发生情况。结果各时间点MAP、HR、CVP组间比较差异无统计学意义(P>0.05);在T4时刻,两组患者血清中NGAL、Cys C、KIM-1均升高且P组明显高于S组,差异有统计学意义(P<0.05),其余时间点两组比较差异无统计学意义(P>0.05);在T3、T4时间点两组患者SDC-1、HS、HA较T0时间点均显著升高且T4时间点P组明显高于S组,差异有统计学意义(P<0.05),其余时间点两组比较差异无统计学意义(P>0.05);在T3、T4时刻两组患者TNF-α、IL-6均明显升高,T5、T6时间点有所下降但仍高于T0,且T4、T5时间点P组明显高于S组,差异有统计学意义(P<0.05);T5、T6时间点MMSE评分均下降,且T5时间点P明显低于S组,差异有统计学意义(P<0.05),T6时间点比较,差异无统计学意义(P>0.05);两组患者术后认知功能障碍发生率比较差异无统计学意义(P>0.05)。结�Objective To compare the application of sevoflurane or propofol anesthesia maintenance in liver transplantation patients and explore its effects on renal function and postoperative cognition and possible mechanisms.Methods A total of 60 patients aged 18~60 years old and ASA gradeⅡ-Ⅲwho were scheduled to undergo orthotopic liver transplantation in our hospital were selected.They were randomly divided into two groups(n=30)according to the different maintenance schemes:group P(propofol group)and group S(sevoflurane group).Anesthesia maintenance:group P received continuous target-controlled infusion of propofol combined with remifentanil hydrochloride injection during surgery;group S received sevoflurane inhalation combined with infusion of remifentanil hydrochloride injection during surgery.The mean arterial pressure(MAP),heart rate(HR)and central venous pressure(CVP)of the two groups of patients were recorded at seven time points,including before anesthesia induction(T0),immediately after skin incision(T1),30 minutes in the anhepatic phase(T2),3 hours in the neohepatic phase(T3),12 hours after surgery(T4),24 hours after surgery(T5)and 72 hours after surgery(T6).3 mL of central venous blood was drawn from each group.The serum neutrophil gelatinase-associated lipocalin(NGAL),serum cystatin C(Cys C),kidney injury molecule 1(KIM-1),syndecan 1(SDC-1),heparin sulfate(HS),hyaluronic acid(HA)and serum concentrations of inflammatory markers(TNF-α,IL-6)were detected by ELISA at the above time points.The cognitive function was evaluated by the Mini-Mental State Examination(MMSE)at T0,T5 and T6,and the occurrence of cognitive dysfunction(MMSE<23 points)was counted.Results There were no significant differences in MAP,HR,and CVP between the two groups at each time point(P>0.05).At T4,the serum levels of NGAL and Cys in the two groups were significantly higher than those in the other groups.C and KIM-1 increased,and the P group was significantly higher than the S group,the difference was statistically significant(P<0.05),and

关 键 词：肝移植 麻醉维持 肾功能 认知功能 丙泊酚 七氟醚 

分 类 号：R614.2[医药卫生—麻醉学]