【摘要】：目的:比較肝功能正常與肝硬化肝功能B級(jí)兩種肝功能狀態(tài)的成人患者,經(jīng)相同七氟烷濃度麻醉相同時(shí)間后測(cè)定其血液中代謝產(chǎn)物游離六氟異丙醇的生成情況。旨在觀察肝功能狀況對(duì)七氟烷代謝的影響,同時(shí)觀察兩組游離六氟異丙醇對(duì)麻醉后恢復(fù)質(zhì)量的影響。方法:選擇擬行擇期腹部手術(shù)的成年患者30例,預(yù)計(jì)手術(shù)時(shí)間為3h左右。依肝功能狀況分為A、B兩組:A組患者為對(duì)照組,肝功正常(n=15),B組患者為試驗(yàn)組,肝硬化肝功Child-Pugh分級(jí)為B級(jí)(n=15)。兩組麻醉誘導(dǎo)后吸入七氟烷濃度1.5MAC,靶控輸注瑞芬太尼(靶濃度4-6ng/ml),持續(xù)靜脈泵注順苯磺酸阿曲庫銨(1-3ug/kg.min)維持麻醉。氧流量2L/min,維持腦干聽覺誘發(fā)電位指數(shù)在15-30。手術(shù)結(jié)束即停用所有藥物,分別于使用七氟烷麻醉后0.5h、1h、2h、3h(停用七氟烷時(shí))及停用后0.5、1h、2h、4h共8個(gè)時(shí)點(diǎn)采集靜脈血各7ml。采用氣相色譜法結(jié)合注射器頂空一次平衡法測(cè)定血樣中游離六氟異丙醇濃度,并于手術(shù)結(jié)束后觀察記錄患者恢復(fù)情況,包括:自主呼吸恢復(fù)時(shí)間(T1)、蘇醒時(shí)間(T2)、定向力恢復(fù)時(shí)間(T3)、指令響應(yīng)時(shí)間(T4)、拔管時(shí)間(T5),并對(duì)拔管即刻、拔管后15min、0.5h、1h、2h、3h、4h進(jìn)行VAS疼痛評(píng)分和Ramsay鎮(zhèn)靜評(píng)分。結(jié)果:在七氟烷麻醉階段,A、B兩組患者血液中游離HFIP濃度均隨七氟烷麻醉時(shí)間延長而逐漸升高并達(dá)峰值,A組在七氟烷麻醉后1h達(dá)峰值,B組在七氟烷麻醉后2h達(dá)峰值,兩組游離HFIP濃度達(dá)峰值后逐漸降低,且停用七氟烷后兩組游離HFIP濃度均繼續(xù)降低。組間比較,在七氟烷麻醉后1小時(shí)血液中游離HFIP濃度B組低于A組(P0.05),其余各對(duì)應(yīng)時(shí)點(diǎn)兩組無顯著性差異(P0.05);B組峰值濃度低于A組,但差異無統(tǒng)計(jì)學(xué)意義(P0.05)。B組自主呼吸恢復(fù)時(shí)間、蘇醒時(shí)間、指令響應(yīng)時(shí)間、定向力恢復(fù)時(shí)間及拔管時(shí)間均大于A組(P0.05);B組拔管后15min、0.5h VAS疼痛評(píng)分低于A組(P0.05),而拔管后0.5h、1h、2h Ramsay鎮(zhèn)靜評(píng)分卻高于A組(P0.05)。結(jié)論:(1)和肝功能正�；颊呦啾�,肝功能B級(jí)對(duì)七氟烷代謝產(chǎn)物六氟異丙醇的生成無明顯影響。(2)肝功能B級(jí)患者接受臨床常用濃度的七氟烷(1.5MAC)麻醉,其麻醉恢復(fù)質(zhì)量與七氟烷代謝產(chǎn)物游離六氟異丙醇無關(guān)。
[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.
【學(xué)位授予單位】：川北醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R614

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