不同浓度七氟烷预处理对肝脏手术缺血再灌注损伤的影响  

Effect of different concentrations of sevoflurane preconditioning on ischemia-reperfusion injury in liver surgery

作　　者：王明明 胡礼宏[1] 何莲莲 WANG Mingming;HU Lihong;He Lianlian(Department of Anesthesiology,Ningbo Medical Center Lihuili Hospital,Ningbo,Zhejiang 315041,China)

机构地区：[1]浙江省宁波市医疗中心李惠利医院麻醉科,315041

出　　处：《重庆医学》2023年第10期1525-1529,共5页Chongqing medicine

基　　金：浙江省宁波市自然科学基金项目(2019A610219)。

摘　　要：目的探讨不同浓度七氟烷预处理对肝脏缺血再灌注损伤(HIRI)的影响。方法选取2022年3-5月在该院行腹腔镜肝脏部分切除的患者60例,采用随机数字表法分为4组:丙泊酚组(P组),1%七氟烷组(S1),2%七氟烷组(S2),3%七氟烷组(S3),每组15例。P组持续输注丙泊酚6 mg·kg^(-1)·h^(-1),各七氟烷组在P组基础上于肝门阻断前吸入相应浓度七氟烷30 min(S1组:1%七氟烷,S2组:2%七氟烷,S3组:3%七氟烷),之后纯氧洗脱15 min。于诱导前(T_(0))、术后1 d(T_(1))、术后3 d(T_(2))、术后5 d(T_(3))、术后7 d(T_(4))5个时间点抽取患者外周静脉血,检测血清谷氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)、超氧化物歧化酶(SOD)、丙二醛(MDA)、肿瘤坏死因子-α(TNF-α)、白细胞介素(IL)-1、IL-10水平,记录患者年龄、体重、阻断时间、手术时间及出血量等一般资料。结果4组患者年龄、体重、阻断时间、手术时间、出血量等一般资料比较,差异均无统计学意义(P>0.05)。4组患者T_(1)~T_(3)各时间点血清ALT、AST、SOD、MDA、TNF-α、IL-1、IL-10水平均较T_(0)时明显升高(P<0.05);T_(1)~T_(3)各时间点,S1、S2和S3组患者血清ALT、AST、TNF-α、IL-1水平均明显低于P组(P<0.016),血清SOD和IL-10水平明显高于P组(P<0.016),且S2组患者血清TNF-α、IL-1水平明显低于S1和S3组(P<0.016),IL-10水平明显高于S1和S3组(P<0.016)。结论不同浓度七氟烷预处理均可以降低HIRI,且2%七氟烷预处理对HIRI的保护作用最佳。Objective To investigate the effects of different concentrations of sevoflurane preconditioning on hepatic ischemia-reperfusion injury(HIRI).Methods A total of 60 patients undergoing laparoscopic partial hepatectomy selected from this hospital from March to May 2022 were divided into four groups according to the random number table method:the propofol group(group P),the 1%sevoflurane concentration group(group S1),the 2%sevoflurane concentration grou p(group S2),and the 3%sevoflurane concentration group(group S3),with 15 cases in each group.In group P,propofol was continuously infused with 6 mg·kg^(-1)·h^(-1).E ach sevoflurane group inhaled corresponding concentrations of sevoflurane for 30 minutes(group S1:1%sevoflurane,group S2:2%sevoflurane,group S3:3%sevoflurane)on the basis of group P,before hepatic portal occlusion,and then eluted with pure oxygen for 15 minutes.Peripheral venous blood was taken from patients in the time of before induction(T_(0)),1 day after operation(T_(1)),3 days after operation(T_(2)),5 days after operation(T_(3)),and 7 days after operation(T_(4)),and the serum levels of alanine aminotransferase(ALT),aspartate aminotransferase(AST),superoxide dismutase(SOD),malondialdehyde(MDA),tumor necrosis factor-α(TNF-α),interleukin-1(IL-1)and interleukin-10(IL-10)were detected,and the general data of patients’age,weight,blocking time,operation time and bleeding volume were recorded.Results There was no statistical significance in age,weight,blocking time,operation time,and bleeding volume among patients in the four groups(P>0.05).The levels of serum ALT,AST,SOD,MDA,TNF-α,IL-1 and IL-10 in the four groups were significantly higher at T_(1)-T_(3) than those at T_(0)(P<0.05).At various time point T_(1)-T_(3),the levels of serum ALT,AST,TNF-αand IL-1 in group S1,S2 and S3 were significantly lower than those in group P(P<0.016),while the levels of serum SOD and IL-10 were significantly higher than those in group P(P<0.016).The levels of serum TNF-αand IL-1 in group S2 were significantly lower th

关 键 词：肝脏切除术 缺血再灌注损伤 七氟烷 预处理 炎症因子 肝功能 

分 类 号：R614[医药卫生—麻醉学]