Sakuramoto C, Shirai M, Kato S, Goto F
Department of Anesthesiology, School of Medicine, Kitasato University, Sagamihara.
Masui. 1993 Aug;42(8):1142-7.
The effects of halothane, isoflurane and epidural anesthesia combined with isoflurane on hemodynamic and metabolic changes caused by hepatic ischemia and reperfusion were studied in 16 pigs. Hepatic arterial and portal venous blood flows were measured electromagnetically. Lactate pyruvate ratio (L/P) and arterial ketone body ratio (AKBR) were calculated as markers of hepatic aerobic metabolism. Total hepatic blood flow (THBF), cardiac output (CO) and THBF/CO showed no significant differences among three anesthetic methods in ischemic and reperfusion period. In the group with epidural anesthesia combined with isoflurane, L/P was significantly lower and AKBR was significantly higher compared with the data obtained in ischemic period. However, hepatic metabolism was severely disturbed after the reperfusion of the liver in all three groups. Especially, halothane group showed the most remarkable decrease in AKBR. In summary, epidural anesthesia will be useful for aerobic hepatic metabolism because of inhibition of the release of endogenous cathecolamines, but hepatic metabolism will not be maintained following hepatic ischemia and reperfusion.
在16头猪身上研究了氟烷、异氟烷以及硬膜外麻醉联合异氟烷对肝缺血再灌注所致血流动力学和代谢变化的影响。采用电磁法测量肝动脉和门静脉血流量。计算乳酸丙酮酸比值（L/P）和动脉酮体比值（AKBR）作为肝脏有氧代谢的指标。在缺血和再灌注期，三种麻醉方法的总肝血流量（THBF）、心输出量（CO）和THBF/CO均无显著差异。与缺血期的数据相比，硬膜外麻醉联合异氟烷组的L/P显著降低，AKBR显著升高。然而，所有三组在肝脏再灌注后肝脏代谢均受到严重干扰。特别是，氟烷组的AKBR下降最为显著。总之，硬膜外麻醉因抑制内源性儿茶酚胺的释放而有利于肝脏的有氧代谢，但在肝缺血再灌注后肝脏代谢无法维持。
