七氟烷预处理对肝脏部分切除术患者肝脏缺血再灌注损伤的影响  

Effect of Preconditioning of Hepatic ischemia Reperfusion Injury on Patients under Partial Hepatectomy with Sevoflurane

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]宁波大学医学院附属李惠利医院麻醉科,315040 [2]西安交通大学医学院第二附属医院麻醉科,710004 [3]宁波大学医学院附属李惠利医院肝胆外科,315040

出　　处：《医学研究杂志》2016年第1期147-149,154,共4页Journal of Medical Research

基　　金：浙江省医学会临床科研资金资助项目(2011ZYC-A52);宁波市医学科技计划项目(2013A01)

摘　　要：目的探讨七氟烷预处理对肝脏部分切除术患者肝脏缺血再灌注损伤的影响和机制。方法选择择期行肝脏部分切除术患者60例,随机分为对照组和观察组,各30例。对照组采用全凭静脉麻醉,观察组采用静吸复合麻醉,并于肝门阻断前吸入2%的七氟烷30min,洗脱15min。于术前(T_0)、手术结束(T_1)、24h(T_2),术后3天(T_3)、5天(T_4)、7天(T_5)各个时间点取中心静脉血,检测肝功能指标丙氨酸氨基转移酶(ALT)、门冬氨酸氨基转移酶(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-6、IL-10,记录术后住院天数。结果观察组血清AST、ALT、MDA、TNF-α和IL-6浓度于术后明显升高,观察组AST、ALT和MDA在T_2、T_3、T_4和T_5等时间点显著低于对照组(P<0.05);观察组血清TNF-α和IL-6在T_1、T_2、T_3和T_4等时间点显著低于对照组(P<0.05);观察组SOD和IL-10浓度于术后明显升高,而对照组变化不明显,观察组血清SOD和IL-10浓度于T_1、T_2、T_3、T_4和T_5等时间点显著高于对照组(P<0.05)。观察组患者术后住院天数明显短于对照组(P<0.05)。结论七氟烷预处理能减轻肝脏部分切除术患者肝脏缺血再灌注损伤,可能是通过抑制TNF-α、IL-6激活和释放,抑制氧自由基的生成和脂质过氧化,促进IL-10的激活和释放来达到的。Objective To observe the effect of preconditioning of hepatic ischemia reperfusion injury on patients under partial hepatectomy with sevofiurane. Methods Sixty patients undergoing elective partial hepatectomy were randomly assigned to control group （30 cases） and treatment group （30 cases）. The control group adopted total introvenouse anaesthesia, the treatment group inhale 2% sevoflu- rane before occlusion of the hepatic hilum within 30rain, and clean 15rain. Serum alanine aminotransferase（ALT） , aspartate aminotransferase（AST） , malondialdehyde （MDA） , superoxide dismutase （SOD） , tumor necrosis factor - α （ TNF - α） , interleukin - 6 （ IL - 6 ） and interleukin - 10（ IL - 10） were determined in the time of pre - operation（ TO ）, 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. Results AST,ALT,MDA,TNF - αand IL -6 were higher than To in control group after operation. AST,ALT and MDA in the T2 ,T3 ,T4 and Ts , TNF - α and IL -6 in the T1 , T2 ,T3and T4 of treatment group were significantly lower than control group（ P 〈 0.05 ）. SOD and IL - 10 were significantly higher than control group in the T1 ,T2 ,T3 ,T4 and Ts （ P 〈 0.05 ）. The length of stay in hospital of treatment group were significantly shorter than control group（ P 〈 0.05 ）. Conclusion Preconditioning of hepatic ischemia reperfusion injury with sevoflurane can alleviate hepatic ischemia reperfusion injury in patients under partial hepatectomy through decreasing the activation and releasing of TNF - α, and IL - 6, suppressing and eliminating oxygen free radicals, accelerating the activation and releasing of IL - 10.

关 键 词：七氟烷 预处理 肝脏部分切除术 缺血再灌注损伤 

分 类 号：R657.3[医药卫生—外科学]