右美托咪定麻醉处理接受肝叶切除术治疗的原发性肝癌患者对肝缺血再灌注损伤的影响分析  

Effect of dexmedetomidine for anesthesia induction on hepatic ischemia-reperfusion injury in patients with primary liver cancer undergoing hepatectomy

作　　者：王海霞[1] 刘忠涛 张苗苗[2] Wang Haixia;Liu Zhongtao;Zhang Miaomiao(Department of Anesthesia,Central Hospital,Jiamusi 154002,Heilongjiang Province,China)

机构地区：[1]黑龙江省佳木斯市中心医院麻醉科,154002 [2]佳木斯大学附属第一医院麻醉手术科

出　　处：《实用肝脏病杂志》2025年第1期136-139,共4页Journal of Practical Hepatology

基　　金：黑龙江省卫生健康委科研项目(编号:2020-365)。

摘　　要：目的探讨应用右美托咪定(DEX)麻醉诱导对接受肝叶切除术治疗的原发性肝癌(PLC)患者肝缺血再灌注损伤(HIRI)的影响。方法2021年6月~2023年1月我院收治的PLC患者81例,被随机分为对照组41例和观察组40例,两组均接受肝叶切除术治疗。给予观察组DEX、芬太尼、顺式阿曲库铵和丙泊酚麻醉诱导,随后给予DEX、瑞芬太尼和丙泊酚静脉滴注维持麻醉至手术结束,在对照组用生理盐水代替DEX,其余麻醉用药与观察组相同。采用ELISA法检测血清丙二醛(MDA)、超氧化物歧化酶(SOD)、谷胱甘肽(GSH)、肿瘤坏死因子-α(TNF-α)、白细胞介素(IL)-6和IL-8水平。结果在肝门阻断、麻醉后1 h、麻醉后6 h和麻醉后24 h时,对照组血清ALT水平分别为(98.1±10.8)U/L、(168.5±13.2)U/L、(196.7±14.9)U/L和(179.1±13.7)U/L,均显著高于观察组【分别为(86.6±10.1)U/L、(124.3±11.3)U/L、(143.8±12.4)U/L和(121.3±11.5)U/L,P<0.05】,AST水平分别为(118.4±11.7)U/L、(186.3±14.0)U/L、(226.3±16.5)U/L和(192.3±15.4)U/L,均显著高于观察组【分别为(92.3±12.1)U/L、(133.6±13.4)U/L、(161.8±15.3)U/L和(136.8±14.0)U/L,P<0.05】,在麻醉后6 h和24 h,对照组血清TBIL水平分别为(26.4±5.1)μmol/L和(31.5±4.8)μmol/L,均显著高于观察组【分别为(18.2±4.8)μmol/L和(22.4±5.0)μmol/L,P<0.05】;在麻醉后1 h、麻醉后6 h和麻醉后24 h时,观察组血清MDA水平显著低于对照组(P<0.05),而血清SOD和GSH水平显著高于对照组(P<0.05);观察组血清TNF-α、IL-6和IL-8水平也均显著低于对照组(P<0.05)。结论应用DEX加入诱导麻醉能减轻接受肝叶切除术治疗的PLC患者HIRI,可能与缓解了围术期氧化应激反应和抑制细胞因子分泌有关,值得进一步研究。Objective The aim of this study was to observe effects of dexmedetomidine(DEX)for anesthesia induction on hepatic ischemia-reperfusion injury(HIRI)in patients with primary liver cancer(PLC)undergoing hepatectomy.Methods A total of 81 patients with PLC were encountered in our hospital between June 2021 and January 2023,and were randomly divided into control(n=41)and observation(n=40)groups.All patients in the two groups underwent hepatectomy,and for anesthesia induction,all patients received intravenous fentanyl,cisatracurium and propofol,and patients in the observation received additional DEX administration,then,all patients received intravenous drip of DEX,remifentanil and propofol for anesthesia untill the end of surgery.Serum malondialdehyde(MDA),superoxide dismutase(SOD),glutathione(GSH),tumor necrosis factor-α(TNF-α),interleukin(IL)-6 and IL-8 levels were detected by ELISA.Results At inflow occlusion,one hour,six hours and twenty-four hours after anesthesia,serum ALT levels in the control group were(98.1±10.8)U/L,(168.5±13.2)U/L,(196.7±14.9)U/L and(179.1±13.7)U/L,all significantly higher than[(86.6±10.1)U/L,(124.3±11.3)U/L,(143.8±12.4)U/L and(121.3±11.5)U/L,respectively,P<0.05],serum AST levels were(118.4±11.7)U/L,(186.3±14.0)U/L,(226.3±16.5)U/L and(192.3±15.4)U/L,all significantly higher than[(92.3±12.1)U/L,(133.6±13.4)U/L,(161.8±15.3)U/L and(136.8±14.0)U/L,respectively,P<0.05]in the observation group,and six hours and twenty-four hours after anesthesia,serum bilirubin levels in the control group were(26.4±5.1)μmol/L and(31.5±4.8)μmol/L,both significantly higher than[(18.2±4.8)μmol/L and(22.4±5.0)μmol/L,respectively,P<0.05]in the observation group;one hour,six hours and twenty-four hours after anesthesia,serum MDA level in the observation group was much lower than in the control(P<0.05),while serum SOD and GSH levels were much higher than in the control group(P<0.05);serum TNF-α,IL-6 and IL-8 levels in the observation group were much lower than in the control group(P<0.05).Conclus

关 键 词：原发性肝癌 肝叶切除术 右美托咪定 肝缺血再灌注损伤 氧化应激 细胞因子 诱导麻醉 

分 类 号：R614[医药卫生—麻醉学] R735.7[医药卫生—外科学]