七氟烷预处理减轻肝癌根治术患者肝脏缺血再灌注损伤  

Sevoflurane pretreatment reduces the liver ischemia reperfusion injury of patients experiencing liver cancer radical operation

作　　者：胡礼宏[1] 徐霞[1] 陈小非[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,浙江宁波315040 [2]西安交通大学医学院第二附属医院麻醉科,陕西西安710004 [3]宁波大学医学院附属李惠利医院肝胆外科,浙江宁波315040

出　　处：《中国现代医生》2016年第1期1-4,8,共5页China Modern Doctor

基　　金：浙江省医学会临床科研资金项目(2011ZYC-A52);浙江省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癌根治术患者肝脏缺血再灌注损伤的影响和机制。方法选择2013年12月~2014年12月择期行肝癌根治术患者60例,随机分为对照组和观察组,每组30例。对照组采用全凭静脉麻醉,观察组采用静吸复合麻醉,于肝门阻断前吸入2%的七氟烷30 min,洗脱15 min。于术前（T0）、手术结束（T1）、术后24 h（T2）,术后3 d（T3）、5 d（T4）、7 d（T5）各个时间点取中心静脉血,检测丙氨酸氨基转移酶（ALT）、门冬氨酸氨基转移酶（AST）、超氧化物歧化酶（SOD）、丙二醛（MDA）、炎性因子TNF-α、IL-1和IL-10。记录术后住院天数。结果与术前比较,两组患者术后血清AST、ALT、MDA、TNF-α、IL-1浓度明显升高（P〈0.05）,观察组AST和ALT在T2~T5等时间点,TNF-α在T1~T4等时间点,MDA和IL-1在T1~T5等时间点显著低于对照组（P〈0.05）,对照组SOD水平变化不明显;观察组血清SOD和IL-10浓度于T1~T5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癌根治术患者肝脏缺血再灌注损伤,可能是通过抑制TNF-α、IL-1激活,抑制氧自由基的生成,促进IL-10的激活和释放来达到的。Objective To explore the impact and mechanism of sevoflurane pretreatment on liver ischemia reperfusion injury of patients experiencing liver cancer radical operation. Methods Sixty patients receiving liver cancer radical operation from December 2013 to December 2014 were selected and randomly and equally divided into control group and observation group. Patients in the control group were given total intravenous anesthesia, while for patients in the observation group, intravenous inhalational anesthesia was applied： 2% sevoflurane inhalation for 30 min before hepatic portal occlusion and elution for 15 min. Central venous blood was sampled at pre-operation（T0）, 0 h（T1）, 24 h（T2）, 3 d（T3）, 5 d（T4）, and 7 d（T5） after operation to detect alanine aminotransferase（ALT）, aspartate aminotransferase（AST）,superoxide dismutase（SOD）, Malondialdehyde（MDA）, and inflammatory factor TNF-α, IL-1 and IL-10. And the length of hospital stay after operation was also recorded. Results Compared to those before operation, serum AST, ALT, MDA,TNF-α and IL-1 of both groups were significantly increased（P〈0.05）. AST and ALT at T2~T5, TNF-α at T1~T4, and MDA and IL-1 at T1~T5 of the observation group were significantly lower than those of the control group（P〈0.05）. SOD of the control group had no evident change, and serum SOD and IL-10 at T1~T5 of the observation group were significantly higher than those of the control group（P〈0.05）. The hospital stay of patients in the observation group were significantly shorter than those of the control group（P〈0.05）. Conclusion Sevoflurane pretreatment can reduce the liver ischemia reperfusion injury of patients experiencing liver cancer radical operation, probably by inhibiting the activation of TNF-α and IL-1 and the production of oxygen free radical, and promoting the activation and release of IL-10.

关 键 词：七氟烷 预处理 肝癌根治术 缺血再灌注损伤 

分 类 号：R614[医药卫生—麻醉学]