摘要
目的探讨丙泊酚对肝移植患者肾功能的保护作用。方法选择择期拟行经典式非转流原位肝移植术的晚期肝硬化或肝癌40例,年龄30～55岁,体重50～75 kg,美国麻醉医师协会(ASA)分级Ⅲ或Ⅳ级,肝功能使用终末期肝病模型(MELD)评分。随机法分为2组(n=20):对照组和丙泊酚组。麻醉诱导:静脉注射咪达唑仑、舒芬太尼、维库溴铵、对照组静脉注射依托咪酯,丙泊酚组静脉注射丙泊酚,气管插管后行机械通气。麻醉维持:对照组持续吸入异氟醚、连续静脉输注顺阿曲库铵,间断静脉注射舒芬太尼;丙泊酚组持续吸入异氟醚、连续静脉输注丙泊酚和顺阿曲库铵,间断静脉注射舒芬太尼。两组维持平均动脉压(MAP)、脑电双频谱指数(BIS)值达标准。于入室(T1)、无肝期初(T2)、无肝期末(T3)、新肝期l h(T4)、新肝期2 h(T5)、关腹(T6)时采集静脉血样测定血浆尿素(blood urea,Urea)、肌酐(creatinine,Cr)、β_2-微球蛋白(β_2-microglobin,β_2-MG)浓度。结果与T1时间点相比,对照组和丙泊酚组Cr在T3、T4、T5、T6时间点升高(P<0.05);对照组Urea在T5、T6时间点升高(P<0.05),丙泊酚组Urea在T2和T3时间点降低、TS和T6时间点升高(P<0.05);对照组β_2-MG在T2时间点降低、T5和T6时间点升高(P<0.05),丙泊酚组β_2-MG在T2时间点降低(P<0.05)。丙泊酚组Cr在T5、T6时间点,Urea在T4、T5、T6时间点,β_2-MG在T6时间点低于对照组(P<0.05)。结论丙泊酚对肝移植患者术中肾功能损伤具有保护作用。
Objective To investigate the effect of propofol on renal function during orthotopic liver transplantation （OLT）. Methods Forty ASA m - Iv patients aged 30 to 55, weighing 50 - 75 kg and undergoing OLT for late stage liver cirrhosis were randomly divided into two groups （n = 20 each） ： control group and propofol group. Anesthesia was induced with midazolam, sufentanil , etomidate in control group and propofol in propofol group. Tracheal intubation was facilitated with veeuronium. The patients were mechanically ventilated. Anesthesia was maintained with isoflurane, continuous infusion 6f cisatracurium and intermittent iv sufentanil in control group but with isoflurane, continuous infusion of propofol and cisatracurium , intermittent iv sufentanil in propofol group. The two groups maintained standard MAP,BIS. Venous blood samples were collected after admission into the operating room （T1） , at the beginning of the anhepatic phase （T2） , at the end of the anhepatic phase （T3） , 1 h and 2 h into the neohepatic phase （T4, T5 ） and closed abdominal（ T6 ） for determination of plasma concentrations of creatinine （Cr）, blood urea （Urea） and β2 -microglobin （β2 - MG）. Results Compared with T1, Cr at T3 ,T4 ,T5 ,T6 increased in both groups. Urea increased at T5 ,T6 in control group but decreased at T2 ,T3 and increased at T5 ,T6 in propofol group. β2 - MG decreased at T2 ,T3, increased at T5 ,T6 in control group but decreased at T2 in propofol group . Cr at T5 ,T6, Urea at T4 ,T5 ,T6 and β2 - MG at T6 in propofol group were all lower than in control group. Conclusions Propofol has protective effect on renal function during liver transplantation.
出处
《武警医学》
CAS
2011年第12期1067-1069,1072,共4页
Medical Journal of the Chinese People's Armed Police Force
关键词
丙泊酚
肝移植
肌酐
血尿素
Β2-微球蛋白
propofol
Liver transplantation
creatinine
blood urea
β2 - microglobin
