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中华肥胖与代谢病电子杂志

中华肥胖与代谢病电子杂志 ›› 2019, Vol. 05 ›› Issue (04) : 196 -200. doi: 10.3877/cma.j.issn.2095-9605.2019.04.004

所属专题： 文献；

论著

不同剂量丙泊酚麻醉对病态肥胖患者肝肾功能的影响
潘桂烽1, 彭雪梅1,†()   
  1. 1. 510000　广州，暨南大学附属第一医院麻醉科
  • 收稿日期:2019-10-24 出版日期:2019-11-30
  • 通信作者: 彭雪梅

Effects of different doses of propofol on hepatic and renal function in morbid obese patients undertook bariatric surgery

Guifeng Pan1, Xuemei Peng1,†()   

  1. 1. Department of Anesthesiology, the First Affiliated Hospital of Jinan University, GuangZhou 510000, China
  • Received:2019-10-24 Published:2019-11-30
  • Corresponding author: Xuemei Peng
  • About author:
    Corresponding author: Peng Xuemei, Email:
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引用本文：

潘桂烽, 彭雪梅. 不同剂量丙泊酚麻醉对病态肥胖患者肝肾功能的影响[J]. 中华肥胖与代谢病电子杂志, 2019, 05(04): 196-200.

Guifeng Pan, Xuemei Peng. Effects of different doses of propofol on hepatic and renal function in morbid obese patients undertook bariatric surgery[J]. Chinese Journal of Obesity and Metabolic Diseases(Electronic Edition), 2019, 05(04): 196-200.

目的

探讨分别按去脂体质量（LBW）、总体质量（TBW）2种剂量使用丙泊酚麻醉对病态肥胖患者行减重术术后肝肾功能的影响。

方法

选择23例ASAI~II级拟行减重手术的患者，随机分为TBW组（I组），LBW组（II组），另选一组正常体重进行腹腔镜手术患者（III组）为对照，使用分别采用不同剂量丙泊酚进行麻醉，记录术前（T1）、术后24 h（T2）、48 h（T3）、72 h（T4）的血清天冬氨酸转氨酶（AST）、丙氨酸转氨酶（ALT）、白蛋白（ALB）、尿素氮（BUN）和β2微球蛋白（β2-MG）等肝肾功能指标。

结果

3组患者组内不同时间点上AST、ALT等肝功能指标的差异无统计学意义（P>0.05），与T1相比，3组患者内的ALB、BUN在T3、T4明显降低（P<0.05）；与T1相比，3组内的β2-微球蛋白在T2、T3时间点明显下降（P<0.05）。

结论

对于病态肥胖患者，两种剂量丙泊酚麻醉对病态肥胖患者的肝肾功能无明显影响，为减少丙泊酚输注综合征等并发症的发生，推荐LBW作为丙泊酚的给药剂量。

关键词: 丙泊酚, 肥胖, 给药剂量, 肝肾功能, 全身麻醉
Objective

To compare the effects of propofol anesthesia on liver and kidney function after weight-loss surgery within two different dose.

Methods

23 ASA class I or II morbid obese patients (BMI≥35 kg/m2) undergoing bariatric surgery will be randomly divided into total body weight grope (group I involved 11 cases) and lean body weight group (group II involved 12 cases) . Another 6 ASA I- II normal weight patients (BMI of 18.5-24 kg/m2) undergoing laparoscopic surgery were enrolled for contrast (group III) . They received defferent dose propofol for anesthesia. Renal and hepatic functions were detected before and on the 6h (T1), 24h (T2), and 72h (T3) after withdrawal propofol, such as serum aspartate aminotransferase (AST), alanine aminotransferase (ALT), albumin (ALB), urea nitrogen (BUN) and β2-microglobulin (β2-MG) and so on.

Results

There were no significant differences in liver function indexes such as AST and ALT at different time point in three groups. Compared with T1, ALB and BUN in the three groups of patients was significantly decrease in T3 and T4 (P<0.05); Compared with T1, B2-microglobulin in the three groups decreased significantly in T2-T3 (P<0.05).

Conclusions

For morbidly obese patients, two different doses of propofol anesthesia have no significant effect on liver and kidney function in morbidly obese patients. To reduce the complications of propofol infusion syndrome, LBW is recommended as the dose of propofol.

Key words: Propofol, Obesity, Drug dosage, Hepatic and renal function, General anesthesia
表1 三组患者一般情况的比较
参数 I组（n=12） II组（n=11） III组（n=6）
年龄 30.9±7.5 30.2±7.3 28.8±10.8
体重(kg) 121.6±43.6 124.1±26.7 55.2±6.0
身高(m) 1.65±0.09 1.67±0.08 1.66±0.05
BMI(kg/m2) 47.8±8.0* 44.6±8.8* 19.3±1.1
表2 三组患者肝肾功能变化
项目 组别 麻醉前（T1） 停丙泊酚24 h（T3） 停丙泊酚72 h（T4）
T(U/ L) I组 53.1±66.1 36.8±15.9 30.3±14.7
? II组 38.2±29.1 45.3±30.7 36.8±20.6
? III组 20.5±8.5 21.3±3.0 23.5±8.1
ALT(U/ L) I组 69.6±56.2 66.2±44.2 59.6±37.7
? II组 55.9±42.9 59.0±41.2 48.6±37.3
? III组 28.7±24.5 36.3±34.2 37.2±27.7
LDH(U/ L) I组 164.5±44.4 180.3±83.2 161.4±28.0
? II组 173.1±32.0 193.2±37.2 174.2±64.5
? III组 160.8±33.4 149.8±34.9 160.3±31.8
TB(μmo l/L) I组 9.8±4.1 10.5±3.0 10.1±2.6
? II组 12.4±2.0 12.6±2.0 12.5±3.2
? III组 11.0±4.0 10.3±2.6 9.4±2.2
TC(mmo l/L) I组 5.23±0.91 5.45±1.05 5.35±1.33
? II组 4.91±1.02 5.18±1.24 4.92±1.44
? III组 4.85±0.54 5.23±0.78 4.92±0.95
TG(mmo l/L) I组 2.17±0.05 2.36±0.85 2.62±1.24
? II组 2.18±0.75 2.68±1.05 2.50±1.43
? III组 1.87±1.02 1.67±0.93 1.98±1.23
ALB(U/ L) I组 45.5±3.2* 37.5±3.8*△ 37.0±3.3*△
? II组 45.6±3.8* 38.1±3.7*△ 38.8±5.3*△
? III组 54.5±3.2 45.7±3.3△ 46.0±4.3△
BUN(mmol/L) I组 4.25±0.91 3.39±1.16△ 3.37±0.81△
? II组 4.15±1.10 3.18±1.19△ 3.49±1.16△
? III组 4.39±0.86 3.25±0.85△ 3.40±0.47△
Scr(mmo l/L) I组 74.3±6.2 75.2±6.5 75.4±6.9
? II组 74.6±13.6 84.9±17.3 83.9±25.9
? III组 79.7±7.3 79.8±10.8 77.3±8.2
CK(U/ L) I组 167.4±138 184.9±128.8 180.9±125.0
? II组 107.8±53.2 222.0±173.3 153.8±147.0
? III组 132.5±71.5 180.0±124.5 234.2±197.1
表3 三组患者β2-MG变化
项目 组别 麻醉前（T1） 停丙泊酚6 h（T2） 停丙泊酚24 h（T3）
B2-MG（mg/L） I组 1.80±0.65 1.12±0.67△ 1.07±0.65△
? II组 1.93±0.38 1.07±0.30△ 1.02±0.33△
? III组 1.87±0.27 1.03±0.18△ 1.09±0.25△
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