腹腔神经丛阻滞对肝部分切除术后肝再生的影响  

Effects of neurolytic celiac plexus block on liver regeneration after partial hepatectomy

作　　者：李军[1] 魏晓红[2] 林露[1] 汪海洋[1] 白树荣[1] 闫洪涛[3] 田伏洲[3] 

机构地区：[1]成都军区总医院麻醉科,成都610083 [2]成都军区总医院心脏外科,成都610083 [3]成都军区总医院普通外科中心博士后工作站,成都610083

出　　处：《西南国防医药》2013年第8期816-819,共4页Medical Journal of National Defending Forces in Southwest China

基　　金：第47批中国博士后科学基金面上资助(20100471764);成都军区总医院院管课题(2011YG-B09)

摘　　要：目的观察腹腔神经丛阻滞(NCPB)对肝部分切除术(PH)大鼠残余肝组织再生的影响。方法采用雄性SD大鼠构建经典大鼠PH模型:即分别于肝左叶、中叶根部结扎切除。然后随机分为对照组和NCPB组,NCPB组在术后12 h开始给予双侧0.5%利多卡因经皮NCPB,1次/d,而对照组以0.9%生理盐水替换。分别于术后第1、3、7 d行NCPB后30 min,观察残肝的增殖情况,并测定肝功能和残肝血流量及血管内皮生长因子(VEGF)的表达。结果 NCPB组大鼠的谷草转氨酶(AST)和谷丙转氨酶(ALT)在PH术后第1、3、7 d均不同程度地低于对照组(P<0.05或P<0.01),总胆红素(TB)在第7 d显著低于对照组(P<0.01),白蛋白在第3、7 d显著高于对照组(P<0.01);对照组的肝血流量在第1 d最低,在第3 d和第7d逐渐增加,而NCPB组的肝血流量在各个时间点均显著高于对照组(P<0.01);PH术后1 d,对照组VEGF的表达量很低,以后逐渐增加,而NCPB组在各相应时间点均显著高于对照组。结论 NCPB减轻大鼠PH术后肝功能损害,可能与提高VEGF表达、改善残余肝组织血液灌注从而促进肝组织再生有关。Objective To investigate the effects of neurolytic celiac plexus block （NCPB） on liver tissue regeneration in rats receiving partial hepatectomy （PH）. Methods Male SD rats were selected to establish the PH model. Ligation and excision were carried out in the left hepatic lobe and the root part of median lobe. Those rats were randomly divided into control and NCPB groups. NCPB group received percutaneous NCPB with 0.5% lidocaine in both sides once per day 12 h after the operation. The control group received the same procedures, but physiological saline was injected instead of 0.5% lidocaine. NCPB was carried out on d 1,3, and 7 after the operation. Thirty minutes after NCPB, the hyperplasy of the remained liver was observed, and the liver function, the blood flow of the remained liver, and the expression level of vascular endothelial growth factor （VEGF） were detected. Results On d 1,3, and 7 after the PH, the AST and ALT contents in the NCPB group were significantly lower than those in the control group （P 〈 0.01 or P 〈 0.05 ）. On d 7, the total hilirubin level of the NCPB group was significantly lower than that of the control group （ P 〈 0.01 ）. On d 3 and 7, the albumin level of the NCPB group was significantly higher that that of the control group （ P 〈 0.01 ）. The hepatic blood flow in the control group was the minimum on d 1 and gradually increased on d 3 and 7. But that in the NCPB group was significantly higher than that in the control group at each time point （P 〈 0. O1 ）. On d 1 after the PH, the expression level of VEGF in the control group was very low but gradually increased afterward. While the expression levels in the NCPB group was higher than those in the control group at each time point. Conclusion NCPB treatment can alleviate the damages of rats＇ liver function after PH, which may be correlated with the increase of VEGF level, the improvement of hemoperfusion in remained liver tissues, and thus the promotion of liver tissue regeneration.

关 键 词：腹腔 神经丛阻滞 肝 切除术 肝功能 血管内皮生长因子 再生修复 

分 类 号：R614.3[医药卫生—麻醉学]