七氟烷预处理对肝叶切除术患者肝脏缺血再灌注损伤的保护作用  

Protective effect of sevoflurane preconditioning of hepatic ischemia reperfusion injury on patients under lobe resection of liver

作　　者：胡礼宏[1] 徐霞[1] 张凯[1] 韩新生[2] 陆才德[3] 

机构地区：[1]宁波市医疗中心李惠利医院麻醉科,315040 [2]西安交通大学医学院第二附属医院麻醉科 [3]宁波市医疗中心李惠利医院肝胆外科,315040

出　　处：《浙江医学》2015年第22期1835-1838,共4页Zhejiang Medical Journal

基　　金：浙江省医学会临床科研资金项目(2011ZYC-A52);宁波市卫生局医学科技计划项目(2013A01)

摘　　要：目的探讨七氟烷预处理对肝叶切除术患者肝脏缺血再灌注损伤的保护作用和机制。方法选择择期行肝叶切除手术息者60例，按随机数字表法分为常规麻醉组（A组）和七氟烷预处理组（B组），每组30例。A组采用全凭静脉麻醉；B组采用静吸复合麻醉，于肝门阻断前吸入2％的七氟烷30min，洗脱15min。于术前（T0）、手术结束（T1）、术后1（T2）、3（T3）、5（T4）和7d（T5）等时点抽取中心静脉血，检测肝功能指标ALT、AST，测定血清超氧化物歧化酶（SOD）和丙二醛（MDA）；检测炎性因子TNF—α、IL-1、IL-10。记录阻断次数、阻断时间、切除肝叶重量、手术时间、出血量、术后住院天数和术后不良事件。结果与术前比较，两组患者术后血清AST、ALT、MDA、TNF—α、IL-1水平均明显升高，A组AST和ALT水平在T2-T5时点，MDA、TNF—α和IL-1在T1-T5时点均明显高于B组（均P〈0．05），B组AST和ALT水平于T5时点恢复正常；B组SOD水平于术后明显升高（P〈0．05），A组各时点SOD水平变化不明显，A组血清SOD和IL-10水平于T1、T2、T3、T4和T5等时点明显低于B组（P〈0．05）。两组患者阻断次数、阻断时间、切除肝叶重量、手术时间、出血量比较差异均无统计学意义（均P〉0．05），B组患者术后住院天数明显短于A组（P〈0．05）。结论七氟烷预处理对肝叶切除术患者肝脏缺血再灌注损伤有保护作用，可能是通过抑制TNF—α、IL-1激活和释放，促进IL-10的激活和释放，抑制氧自由基的生成来达到的。Objective To observe the protective effect and machanisms of sevoflurane preconditioning of hepatic ischemia reperfusion injury on patients under lobe resection of liver. Methods Sixty patients undergoing elective lobe resection of liver were randomly assigned to routine general anaesthesia group （group A） and precondition group （group B）, The group A adopted total introvenouse anaesthesia, the group B inhale 2% sevoflurane before occlusion of the hepatic hilum within 30min,and clean 15min, Serum alanine aminotransferase （ALT）, aspartate aminotransferase （AST）, malondialdehyde （MDA）, superoxide dismutase （SOD）, tumor necrosis factor -α （TNF-α）, interleukin-1 （IL-1） and interleukin-10 （IL-10） were determined in the time of pre-operation（T0）, the end of operation（T1）, post operation 24 hours（T2）, 3days（T3）, 5days（T4） and 7days（T5） to note the days post operation in patients room and adverse reactions. Results AST, MDA, SOD, TNF- cx and IL-1 were higher than To in each goup after operation （P〈0.05）, ALT, AST in the T2, T3, T4 and T5, MDA, TNF-α and IL-1 in the T1 ,T2, T3, T4 and T5 of group B were significantly lower than group A （P〈0.05）, SOD and IL-10 of group B were significantly higher than group A in the T1, T2, T3, T4 and T5 （P〈0.05）, the length of stay in hospital of group B were significantly shorter than group A （P〈0.05）. Conclusion Sevoflurane preconditioning can alleviate hepatic ischemia reperfusion injury on patients under lobe resection of liver through decrease the activation and release of TNF- α, and IL-1, suppress and eliminate oxygen free radicals, accelerate the activation and release of IL-10.

关 键 词：七氟烷 肝叶切除术 肝脏 缺血再灌注损伤 

分 类 号：R614[医药卫生—麻醉学]