海南医科大学学报

目的:研究肝炎肝硬化患者术中两种麻醉方式对肝肾及免疫指标的影响,为临床麻醉选择合适的方案提供依据。方法:选择湖北省襄阳市中心医院接受脾切除断流手术治疗的肝炎肝硬化患者50例,随机分成观察组(25例)和对照组(25例),观察组使用静吸复合麻醉,对照组使用全凭静脉麻醉。对比麻醉前、诱导后2h以及术后1d等时间患者的肝肾功能和免疫功能情况。结果:麻醉前,两组肝、肾功能指标比较差异无统计学意义(P>0.05)。观察组诱导后2h及术后1d的白蛋白(Albumin,ALB)水平显著高于对照组;术后1d的丙氨酸转氨酶(Alanine aminotransferase,ALT)水平显著低于对照组(P<0.05)。观察组组内不同时间的肝功能变化幅度显著小于对照组(P<0.05)。观察组诱导后2h与术后1d的尿素氮(BUN)、肌酐(Creatinine,Cr)水平均显著低于对照组,差异均有统计学意义(均P<0.05)。观察组组内不同时间的肾功能变化幅度亦显著小于对照组(P<0.05)。麻醉前两组CD4⁺、CD8⁺、CD4⁺/CD8⁺比较无统计学差异(P>0.05),诱导后2h与术后1d观察组CD4⁺、CD4⁺/CD8⁺均显著高于对照组(均P<0.05)。结论:七氟醚静吸复合麻醉对肝炎肝硬化患者肝肾功能和免疫功能影响相对较轻,适合肝炎肝硬化患者应用。

Objective:To discuss the effect of two kinds of anesthesia methods during operation on hepatic and renal function and immune indexes of hepatitis hepatocirrhosis patients and then to provide basis for selection of clinical anesthesia appropriate schemes.Method:A total of 50 cases with hepatitis hepatocirrhosis who underwent splenectomy disconnection operation in our hospital were selected and then were divided into study group(25cases)and control group(25cases).Patients in study group were given intravenous inhalational anesthesia treatment,while patients in control group were given total intravenous anesthesia treatment.Hepatic and renal function and immune function of patients were compared 2hbefore anesthesia、induction and 1dafter operation.Results:Before anesthesia,hepatic and renal function indexes of patients in both groups showed no statistical significant difference(P>0.05).Two hours after induction and 1dafter operation,albumin levels of patients in study group were significantly higher than that in control group;while 1dafter operation,alanine aminotransferase levels of patients were significantly lower than that in control group(P<0.05).Intra-group hepatic function variation range at different time in study group was significantly less than that in control group(P<0.05).Two hours after induction and 1dafter operation,BUN,Creatinine levels of patients in study group were significantly lower than that in control group(P<0.05).Intragroup renal function variation range at different time in study group was also significantly less than that in control group(P<0.05).Before anesthesia,CD4⁺,CD8⁺,CD4⁺/CD8~+levels in both groups showed no statistical significant difference(P>0.05),2hafter induction and 1dafter operation,CD4⁺,CD4⁺/CD8~+levels of patients in study group were significantly higher than that in control group(P<0.05).Conclusions:Effect of sevoflurane intravenous inhalational anesthesia treatment on hepatic and renal function and immune function of hepatitis hepatocirrhosis patients are relatively more significant,which is suitable for hepatitis hepatocirrhosis patients.