七氟醚在不同气体流量下产生A物质浓度差异及对患者肝肾功能影响

【作者】 何凯；

【导师】 叶铁虎；

【作者基本信息】 中国协和医科大学 ， 临床医学， 2008， 博士

【摘要】 背景:七氟醚是世界范围内广泛使用的吸入性麻醉气体,具有众多的临床优点。但是七氟醚和CO₂吸附剂会发生反应,并生成A物质（CA）。CA对小鼠具有肾脏毒性。七氟醚产生CA量的多少取决于CO₂吸附剂中含有的强碱以及水分的多少,以及所使用的气体流量和麻醉仪器。该研究的目的是为了验证在协和医院麻醉科的常规设定下,当患者接受相同浓度和时间的七氟醚暴露时,低气体流量（500ml/min）和高气体流量（2L/min）产生的CA浓度差异,以及患者术前-术后肝肾功能的变化情况。方法:选择接受普通外科手术的患者（n=16）,随机分为高流量组和低流量组。在手术过程中维持患者血压水平稳定（±20%）以及潮气末CO₂浓度,并且根据需要使用镇痛药物。麻醉开始后,每隔30分钟在呼吸管路的吸气端取样,检测CA浓度,同时记录患者的SEV浓度。分别在术前、术后检测患者的肝肾功能（ALT、AST、Tbil、Dbil、BUN、Cr）。结果:两组患者的SEV浓度（0.9692vs0.9675MAC）以及浓度-时间之间（2.40vs2.41MAC-h）不存在显著差异（p＞0.05）。但是两组的CA浓度（27.70vs11.54ppm）和曲线下面积（AUC）之间（55.76vs23.19ppm-h）存在显著差异。两组患者术前、术后的肝肾功能指标（ALT、AST、Tbil、Dbil、BUN、Cr）无显著改变。结论:低流量（500ml）和高流量（2L/min）条件下吸入SEV所产生的CA浓度存在显著差异,但是并不会引起患者术前、术后肝肾功能指标的改变,包括ALT、AST、Tbil、Dbil、BUN、Cr。更多还原

【Abstract】 Background:Sevoflurane is the most popular anesthetic gas in the world,it exhibits many clinical advantages.But sevoflurane is degraded by CO₂ absorbents to Compound A（CA）。CA is known to be nephrotoxic in rats。The amount of CA depends on the strong base and water contents of the carbon dioxide absorbent used,as well as the flow rate and anesthetic machine。The purpose of this study was to measure the amounts of CA produced under the routine circumstances of department of anesthesiology in PUMCH, compare CA concentrations between low-flow anesthesia（500ml） and high-flow anesthesia（2L/min）,and the changes of markers of renal and liver injury or dysfunction。Methods:the general surgical patients（n=16） were randomized to low-flow anesthesia group and high-flow anesthesia group。Maintain the blood pressure（baseline±20%） and the end-tidal CO₂,use analgesic as needed。Gas samples were taken from the inspiratory limbs of the anesthetic circuit in 30-minites interval during anesthesia。Record the SEV concentration。Analyze the markers of renal and liver injury or dysfunctions pre-and post-surgery。Results:there were no statistical differences（p＞0.05） between SEV concentration （0.9692vs0.9675MAC） and concentration-time（2.40vs2.41MAC-h）。there were significant differences（P＜0.01） between CA concentrations（27.70vs11.54ppm） and AUC（55.76vs23.19ppm-h）。all markers of hepatic and renal function（ALT、AST、Tbil、Dbil、BUN、Cr） were unchanged after anesthesia。Conclusion:CA concentrations between low-flow（500ml） and high-flow（2L/min） anesthesia were significantly different,but it did not result in any significant change to markers of hepatic and renal function,including ALT、AST、Tbil、Dbil、BUN、Cr。更多还原