肝功能障碍患者对七氟烷代谢产物游离六氟异丙醇的影响

发布时间：2018-09-14 12:40

【摘要】：目的:比较肝功能正常与肝硬化肝功能B级两种肝功能状态的成人患者,经相同七氟烷浓度麻醉相同时间后测定其血液中代谢产物游离六氟异丙醇的生成情况。旨在观察肝功能状况对七氟烷代谢的影响,同时观察两组游离六氟异丙醇对麻醉后恢复质量的影响。方法:选择拟行择期腹部手术的成年患者30例,预计手术时间为3h左右。依肝功能状况分为A、B两组:A组患者为对照组,肝功正常(n=15),B组患者为试验组,肝硬化肝功Child-Pugh分级为B级(n=15)。两组麻醉诱导后吸入七氟烷浓度1.5MAC,靶控输注瑞芬太尼(靶浓度4-6ng/ml),持续静脉泵注顺苯磺酸阿曲库铵(1-3ug/kg.min)维持麻醉。氧流量2L/min,维持脑干听觉诱发电位指数在15-30。手术结束即停用所有药物,分别于使用七氟烷麻醉后0.5h、1h、2h、3h(停用七氟烷时)及停用后0.5、1h、2h、4h共8个时点采集静脉血各7ml。采用气相色谱法结合注射器顶空一次平衡法测定血样中游离六氟异丙醇浓度,并于手术结束后观察记录患者恢复情况,包括:自主呼吸恢复时间(T1)、苏醒时间(T2)、定向力恢复时间(T3)、指令响应时间(T4)、拔管时间(T5),并对拔管即刻、拔管后15min、0.5h、1h、2h、3h、4h进行VAS疼痛评分和Ramsay镇静评分。结果:在七氟烷麻醉阶段,A、B两组患者血液中游离HFIP浓度均随七氟烷麻醉时间延长而逐渐升高并达峰值,A组在七氟烷麻醉后1h达峰值,B组在七氟烷麻醉后2h达峰值,两组游离HFIP浓度达峰值后逐渐降低,且停用七氟烷后两组游离HFIP浓度均继续降低。组间比较,在七氟烷麻醉后1小时血液中游离HFIP浓度B组低于A组(P0.05),其余各对应时点两组无显著性差异(P0.05);B组峰值浓度低于A组,但差异无统计学意义(P0.05)。B组自主呼吸恢复时间、苏醒时间、指令响应时间、定向力恢复时间及拔管时间均大于A组(P0.05);B组拔管后15min、0.5h VAS疼痛评分低于A组(P0.05),而拔管后0.5h、1h、2h Ramsay镇静评分却高于A组(P0.05)。结论:(1)和肝功能正常患者相比,肝功能B级对七氟烷代谢产物六氟异丙醇的生成无明显影响。(2)肝功能B级患者接受临床常用浓度的七氟烷(1.5MAC)麻醉,其麻醉恢复质量与七氟烷代谢产物游离六氟异丙醇无关。
[Abstract]:Aim: to compare the levels of free hexafluoropropanol in the blood of adult patients with normal liver function and liver function B grade with the same sevoflurane concentration anesthesia for the same time. To observe the effect of liver function on sevoflurane metabolism and the effect of free hexafluoropropanol on recovery quality after anesthesia. Methods: 30 adult patients undergoing elective abdominal surgery were selected and the operative time was estimated to be about 3 hours. According to the status of liver function, the patients in group A were divided into two groups: control group, group B with normal liver function (n = 15), group B with Child-Pugh grade B (n = 15), group B with normal liver function (n = 15) and group B with Child-Pugh grade B (n = 15). After anesthesia induction, anesthesia was maintained by inhalation of 1.5 MAC, target-controlled infusion of remifentanil (4-6ng/ml) and continuous intravenous infusion of atracurium cis-benzenesulfonate (1-3ug/kg.min). Oxygen flow 2 L / min maintains a brainstem auditory evoked potential index of 15 to 30. All drugs were stopped at the end of the operation. Venous blood was collected at 0.5 h, 1 h, 2 h, 3 h after sevoflurane anesthesia, and 0.5 h, 1 h, 2 h and 4 h, respectively, and venous blood was collected at 8 time points (7 ml each) after sevoflurane anesthesia. The concentration of free hexafluoropropanol in blood samples was determined by gas chromatography combined with headspace equilibrium method of syringe, and the recovery of patients was recorded after operation. It included: spontaneous respiration recovery time (T1), recovery time of recovery (T2), recovery time of directional force (T3), response time of instruction (T4), extubation time (T5), and VAS pain score and Ramsay sedation score for 4 h after extubation, 0.5 h after extubation, 1 hour after extubation and 3 hours after extubation. Results: during sevoflurane anesthesia, the concentration of free HFIP in both groups gradually increased with the prolongation of sevoflurane anesthesia time, and reached the peak in group A at 1 hour after sevoflurane anesthesia and the peak in group B at 2 hours after sevoflurane anesthesia. The concentration of free HFIP in both groups decreased gradually after reaching the peak level, and the concentration of free HFIP in both groups continued to decrease after sevoflurane discontinuation. The concentration of free HFIP in blood of group B was lower than that of group A at 1 hour after sevoflurane anesthesia (P0.05), and there was no significant difference between the other two groups (P0.05). The peak concentration of group B was lower than that of group A (P0.05), but there was no significant difference in the recovery time of spontaneous respiration in group B (P0.05). Recovery time, command response time, directional recovery time and extubation time were higher in group A than those in group A (P0.05). The VAS pain score in group B was lower than that in group A at 15 minutes after extubation (P0.05), but the Ramsay sedation score at 1 hour after extubation was higher than that in group A (P0.05). Conclusion: (1) the level B of liver function has no significant effect on the production of hexafluoropropanol, which is the metabolite of sevoflurane, compared with the patients with normal liver function. (2) the patients with grade B of liver function are anesthetized with sevoflurane (1.5MAC). The quality of anesthesia recovery was not related to the free hexafluoroisopropanol, a sevoflurane metabolite.
【学位授予单位】：川北医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R614

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