高渗盐水对肝脏缺血再灌注损伤保护作用的临床研究  

Study of the protective effects of hypertonic saline against ischemia-reperfusion injury of the liver

作　　者：张岩[1] 智绪亭[2] 张建民[1] 侯跃东[1] 

机构地区：[1]山东大学齐鲁医院麻醉科,山东济南250012 [2]山东大学齐鲁医院普外科,山东济南250012

出　　处：《中国现代普通外科进展》2009年第4期313-316,共4页Chinese Journal of Current Advances in General Surgery

摘　　要：目的:观察高渗盐水对肝部分切除术中常温下肝脏缺血再灌注损伤的保护作用。方法:60例择期行肝部分切除术的患者,ASAⅠ～Ⅱ级,随机分为无肝门阻断组(NPR组)、肝门阻断组(PR)和高渗盐水预处理的肝门阻断组(HS组),每组20例。患者均采用硬膜外复合全身麻醉。NPR组不进行肝门阻断,PR组在肝门阻断前5min输入生理盐水,HS组在肝门阻断前5min静脉输入7.5%高渗盐水。分别于术前和肝部分切除后3、15、30min及2h抽取肘静脉血行中性粒细胞(PMN)计数,于术后24和48h抽取肘静脉血检测肝功能;在肝部分切除前及切除后30min取肝组织检测髓过氧化物酶(myeloper-oxidase,MPO)含量。结果:NPR组在肝部分切除后血中性粒细胞计数及肝组织中MPO浓度无变化,但PR组和HS组PMN显著降低(P<0.05),肝组织中MPO浓度显著升高(P<0.05),且PR组变化更为显著(P<0.05);术后3组患者的血浆ALT均升高,PR组升高最为明显,显著高于其他两组(P<0.05)。结论:7.5%高渗盐水预处理对常温下肝脏的缺血再灌注损伤有显著保护作用,其机制可能与减少PMN在肝组织内的聚集有关。Objective： To investigate the protective effects and the mechanism of the preconditioning with hypertonic saline against warm hepatic ischemia-reperfusion （I-R） injury. Methods： Sixty patients who underwent partial liver resection were randomly assigned to 3 groups （n =20.）： group 1 without Pringle maneuver （NPR）; group 2 with Pringle maneuver （PR）. and grooup 3 with 7.5% hypertonic saline 4ml/kg preconditioning （HS） 5 minutes before Pringle maneuver for resection and in group 2,4mt/kg normal saline were given. Blood samples were obtained at 3, 15, and 30 minutes before and after liver resection, and 2, 24, and 48 hours following resection of the liver for polymorphonuclear leukocytes （PMN） count and serum alanine transminase levels test. In addition, small pieces of liver tissue were cut from remaining liver before resection and 30 minutes after resection to determine MPO concentrations. Results.. Following partial liver resection via NPR, no changes in the concentration of circulating PMN and liver MPO concentrations were observed. But in the PR and HS group PMN counts significantly decreased and liver MPO concentrations significantly increased. Serum ALT levels increased in all groups significantly 24 and 48 hours after resection. All of these changes were most pronounced in the PR group and significantly reduced by hypertonic saline, Concusion： Preconditioning with 7.5% hypertonic saline can protect liver from warm ischemia reperfusion injury and the possible mechanism was the inhibition of PMN accumulation in the liver.

关 键 词：肝切除术 再灌注损伤 高渗盐水 

分 类 号：R657.3[医药卫生—外科学]