七氟醚预处理对肝癌切除术患者肠损伤的影响  

Effect of sevoflurane preconditioning on intestinal injury in patients undergoing resection for liver cancer

作　　者：韦美良[1] 陈序[1] 原见春[1] 

机构地区：[1]广西医科大学第一附属医院麻醉科,南宁市530021

出　　处：《中华麻醉学杂志》2014年第11期1306-1308,共3页Chinese Journal of Anesthesiology

摘　　要：目的 探讨七氟醚预处理对肝癌切除术患者肠损伤的影响.方法 选择右肝癌切除术患者40例,性别不限,年龄20 ～ 60岁,体重50 ～ 75 kg,ASA分级Ⅱ或Ⅲ级,肝功能Child-Pugh分级A级,采用随机数字表法分为2组（n=20）：七氟醚预处理组（S组）和对照组（C组）.S组气管插管后开始吸入七氟醚,呼气末七氟醚浓度2.0％,持续吸入30 min后洗出.于麻醉诱导前（T0）、肝门阻断即刻（T1）、肝门开放1 h（T2）、开放3 h（T3）、开放6 h（T4）、术后24 h（T5）时抽取动脉血样,采用EHSA法测定血清TNF-α、肠脂肪酸结合蛋白（Ⅰ-FABP）和D-乳酸盐的浓度.结果 2组患者血清TNF-α和D-乳酸盐浓度于T2时开始升高,T4时达峰值,T5时开始下降（P＜0.05）;血清Ⅰ-FABP浓度于T2时开始升高,T3时达峰值,T4时开始下降（P＜0.05）.与C组比较,S组T2-T5时血清TNF-α、Ⅰ-FABP和D-乳酸盐浓度降低（p＜0.05）.结论 七氟醚预处理可抑制机体炎性反应,减轻肝癌切除术患者肠损伤.Objective To evaluate the effect of sevoflurane preconditioning on intestinal injury in the patients undergoing resection for liver cancer.Methods Forty patients of both sexes,aged 20-60 yr,weighing 5075 kg,of ASA physical status Ⅱ or Ⅲ （liver function Child-Pugh grade A）,undergoing resection for right liver cancer,were randomly divided into 2 groups （n =20 each）：sevoflurane preconditioning group （S group） and control group （C group）.Anesthesia was induced with target-controlled infusion of propofol and remifentanil.Tracheal intubation was facilitated with cisatracurium.Anesthesia was maintained with target-controlled infusion of propofol and remifentanil.S group inhaled sevoflurane with the end-tidal concentration of 2.0％ for 30 min starting from the end of intubation,followed by washout.Before induction （T0）,immediately after hepatic portal was clamped （T1）,at 1,3 and 6 h after occlusion of hepatic portal was released （T2-4） and at 24 h after operation （T5）,arterial blood samples were obtained for determination of serum tumor necrosis factor-alpha （TNF-α）,intestinal fatty acids binding protein （Ⅰ-FABP） and D-lactate levels.Results The concentrations of serum TNF-α and D-lactate started to rise at T2,peaked at T4,and started to decline at T5,and the serum Ⅰ-FABP concentrations started to rise at T2,peaked at T3,and started to decline at T4 in the two groups.The concentrations of serum TNF-α,Ⅰ-FABP and D-lactate were significantly lower in S group than in C group.Conclusion Sevoflurane preconditioning can inhibit inflammatory responses and reduce intestinal injury in the patients undergoing resection for liver cancer.

关 键 词：麻醉药 吸入 缺血预处理 再灌注损伤 肠 肝切除术 

分 类 号：R735.7[医药卫生—肿瘤]