Beyaz Serbülent Gökhan, Yelken Birgul, Kanbak Güngor
Department of Anesthesiology, Sakarya University Medical School, Korucuk Campus, Sakarya, Turkey.
Indian J Anaesth. 2011 Nov;55(6):567-72. doi: 10.4103/0019-5049.90610.
Although most general anaesthesia procedures are performed without any complications, volatile agents may have adverse effects on various living systems. This study aims to compare the antioxidant effects of isoflurane and N-acetylcysteine (NAC) on liver function.
Forty-one patients in the ASA I-II risk groups, who were scheduled to undergo gynaecologic laparoscopy, were randomly divided into two groups: The placebo (group P, n=21) and the NAC group (group N, n=20). In both groups, anaesthesia was maintained with 1-2% isoflurane in 50% Oxygen-50% N(2)O at 6 l/min, also administered by inhalation. Venous blood samples were obtained before anaesthesia induction, and then in the postoperative 1(st) hour and at the 24(th) hour. The samples were centrifuged and serum levels of glutathione S-transferase (GST), malondialdehyde (MDA), aspartate amino transferase (AST), alanine amino transferase (ALT), lactate dehydrogenase (LDH), gamma glutamyltranspeptidase (GGT), prothrombin time (PT), activated partial thromboplastin time (aPTT) and international normalised ratio were determined.
GST levels were significantly higher in group N than in group P in the postoperative 1(st) hour. Postoperative values of GST in the two groups were higher when compared to preoperative values (P<0.05). When postoperative levels were compared with preoperative levels, the postoperative MDA levels of group N were significantly higher (P<0.05). Levels of AST, ALT, GGT and LDH in both groups revealed significant decreases at the postoperative 1(st) hour and postoperative 24(th) hour compared to preoperative values (P<0.05, P<0.001). PT values were significantly higher in both groups in the postoperative 1(st) hour and 24(th) hour (P<0.05, P<0.001), although there were no differences in aPTT levels.
Our results showed that liver functions were well preserved with administration of NAC during anaesthesia with isoflurane. Isoflurane with NAC has lesser effect on liver function tests compared to isoflurane alone.
尽管大多数全身麻醉手术都能顺利进行且无并发症，但挥发性麻醉剂可能会对各种生命系统产生不良影响。本研究旨在比较异氟烷和N-乙酰半胱氨酸（NAC）对肝功能的抗氧化作用。
将41例美国麻醉医师协会（ASA）I-II级风险组、计划接受妇科腹腔镜手术的患者随机分为两组：安慰剂组（P组，n = 21）和NAC组（N组，n = 20）。两组均通过吸入以6 l/min的流速给予50%氧气-50%氧化亚氮混合气体，并加入1%-2%的异氟烷维持麻醉。在麻醉诱导前、术后第1小时和第24小时采集静脉血样本。样本经离心后，测定血清中谷胱甘肽S-转移酶（GST）、丙二醛（MDA）、天冬氨酸氨基转移酶（AST）、丙氨酸氨基转移酶（ALT）、乳酸脱氢酶（LDH）、γ-谷氨酰转肽酶（GGT）、凝血酶原时间（PT）、活化部分凝血活酶时间（aPTT）以及国际标准化比值。
术后第1小时，N组的GST水平显著高于P组。两组术后GST值均高于术前值（P<0.05）。与术前水平相比，N组术后MDA水平显著升高（P<0.05）。与术前值相比，两组术后第1小时和第24小时的AST、ALT、GGT和LDH水平均显著降低（P<0.05，P<0.001）。两组术后第1小时和第24小时的PT值均显著升高（P<0.05，P<0.001），而aPTT水平无差异。
我们的结果表明，在异氟烷麻醉期间给予NAC可良好地保护肝功能。与单独使用异氟烷相比，异氟烷联合NAC对肝功能检查的影响较小。
