Metalloproteinase expression after desflurane preconditioning in hepatectomies:A randomized clinical trial  

作　　者：Eleni Koraki Ioannis Mantzoros Christos Chatzakis Anna Gkiouliava Angeliki Cheva Athina Lavrentieva Freideriki Sifaki Helena Argiriadou Isaak Kesisoglou Konstantinos Galanos-Demiris Stefanos Bitsianis Konstantinos Tsalis 

机构地区：[1]Department of Anaesthesiology,“G Papanikolaou”General Hospital,Thessaloniki 57010,Greece [2]Fourth Department of Surgery,Medical School,Aristotle University of Thessaloniki,Thessaloniki 57010,Greece [3]Department of Pathology,Medical School,Aristotle University of Thessaloniki,Thessaloniki 54636,Greece [4]First Department of Intensive Care Unit,"G Papanikolaou"General Hospital,Thessaloniki 57010,Greece [5]Department of Anaesthesiology and Intensive Care Unit,Aristotle University of Thessaloniki,AHEPA University Hospital,Thessaloniki 54636,Greece [6]Third Department of Surgery,Aristotle University of Thessaloniki,AHEPA University Hospital,Thessaloniki 54636,Greece

出　　处：《World Journal of Hepatology》2020年第11期1098-1114,共17页世界肝病学杂志（英文版）（电子版）

摘　　要：BACKGROUND Hepatectomy with inflow occlusion results in ischemia-reperfusion injury;however,pharmacological preconditioning can prevent such injury and optimize the postoperative recovery of hepatectomized patients.The normal inflammatory response after a hepatectomy involves increased expression of metalloproteinases,which may signal pathologic hepatic tissue reformation.AIM To investigate the effect of desflurane preconditioning on these inflammatory indices in patients with inflow occlusion undergoing hepatectomy.METHODS This is a single-center,prospective,randomized controlled trial conducted at the 4th Department of Surgery of the Medical School of Aristotle University of Thessaloniki,between August 2016 and December 2017.Forty-six patients were randomized to either the desflurane treatment group for pharmacological preconditioning(by replacement of propofol with desflurane,administered 30 min before induction of ischemia)or the control group for standard intravenous propofol.The primary endpoint of expression levels of matrix metalloproteinases and their inhibitors was determined preoperatively and at 30 min posthepatic reperfusion.The secondary endpoints of neutrophil infiltration,coagulation profile,activity of antithrombin III(AT III),protein C(PC),protein S and biochemical markers of liver function were determined for 5 d postoperatively and compared between the groups.RESULTS The desflurane treatment group showed significantly increased levels of tissue inhibitor of metalloproteinases 1 and 2,significantly decreased levels of matrix metalloproteinases 2 and 9,decreased neutrophil infiltration,and less profound changes in the coagulation profile.During the 5-d postoperative period,all patients showed significantly decreased activity of AT III,PC and protein S(vs baseline values,P<0.05).The activity of AT III and PC differed significantly between the two groups from postoperative day 1 to postoperative day 5(P<0.05),showing a moderate drop in activity of AT III and PC in the desflurane treatment group an

关 键 词：DESFLURANE PRECONDITIONING HEPATECTOMY INFLAMMATION METALLOPROTEINASES Reperfusion injury 

分 类 号：R657.3[医药卫生—外科学]