肝炎肝硬化患者围手术期应用全静脉麻醉与静吸复合麻醉的疗效比较

Comparison of the Efficacy of Perioperative Total Intravenous Anesthesia and Intravenous Inhalation Combined Anesthesia in Patients with Hepatitis and Cirrhosis

摘要: 目的：比较肝炎肝硬化患者应用全静脉麻醉和静吸复合麻醉的临床疗效及不良反应的差异，分析肝炎肝硬化患者围手术期最佳麻醉方式。方法：选择行择期手术的肝炎肝硬化患者82例，随机分成2组，每组各41例。全静脉组应用丙泊酚全凭静脉麻醉，复合组采用异氟醚及丙泊酚静吸复合麻醉。于麻醉前(T₀)、拔管后60 min (T₁)及术后1 d (T₂)、3 d (T₃)时间点，分别比较2组改良Aldrete评分、自由基指标的差异。术后记录比较2组呛咳反应及术后恶心呕吐(post-operative nausea and vomiting, PONV)等并发症发生率的差异。结果：复合组与全静脉组的T₀时刻2组患者改良Aldrete评分、血清超氧化物歧化酶(superoxide dismutase, SOD)及丙二醛(malondialdehyde, MDA)水平无显著差异(P > 0.05)；T₁、T₂及T₃时刻，复合组改良Aldrete评分、血清SOD水平均高于全静脉组(P < 0.05)，血清MDA低于全静脉组(P < 0.05)。术后2组呛咳反应及PONV发生率无显著差异(P > 0.05)。结论：肝炎肝硬化患者围手术期应用静吸复合麻醉能显著提高临床疗效，减轻氧自由基，安全性较好。

Abstract: Objective: To compare the clinical efficacy and adverse reactions of total intravenous anesthesia and combined intravenous and inhalation anesthesia in patients with hepatitis and cirrhosis, and to an-alyze the best perioperative anesthesia method for patients with hepatitis and cirrhosis. Method: 82 patients with hepatitis and cirrhosis who underwent elective surgery were randomly divided into 2 groups, with 41 patients in each group. The total intravenous group received intravenous anesthesia with propofol, while the composite group received intravenous anesthesia with isoflu-rane and propofol. At the time points before anesthesia (T₀), 60 minutes after extubation (T₁), and 1 day (T₂) and 3 days (T₃) after surgery, the differences in the modified Aldrete score and free rad-ical index between the two groups were compared. The differences in the incidence of coughing re-actions and postoperative nausea and vomiting (PONV) complications between the two groups after surgery were compared. Results: There was no significant difference between the composite group and the whole vein group in the modified Aldrete score, serum superoxide dismutase (SOD) and malondialdehyde (MDA) levels at T₀ time between the two groups (P > 0.05); At T₁, T₂, and T₃, the modified Aldrete score and serum SOD level in the composite group were higher than those in the whole vein group (P < 0.05), while serum MDA was lower than those in the whole vein group (P < 0.05). There was no significant difference in cough response and PONV incidence between the two groups after surgery (P > 0.05). Conclusion: The perioperative use of intravenous and inhalation combined anesthesia in patients with hepatitis and cirrhosis can significantly improve clinical effi-cacy, reduce oxygen free radicals, and have good safety.