肝叶切除时维拉帕米预处理对肝脏缺血再灌注损伤的保护作用  

Protective Effects of Verapamil on Ischemic Precondition for Resection of Liver

作　　者：杨勇[1] 杨汉新[1] 梁平[1] 刘吉奎 

机构地区：[1]第三军医大学新桥医院肝胆外科,重庆400037 [2]西南肝胆外科医院

出　　处：《中国医师杂志》2003年第5期587-589,共3页Journal of Chinese Physician

摘　　要：目的　探讨维拉帕米在临床肝部分切除时对肝脏缺血再灌注损伤的保护作用。方法　采用Pringle手法阻断第一肝门 18～ 2 0min。将 3 9例合并肝硬化的肝叶切除患者随机分为对照组 (n =19)和实验组 (n =2 0 ) ,分别在肝门阻断前经胃右静脉注入 2 0ml生理盐水和维拉帕米 5mg +生理盐水 2 0ml予处理 ;测定术后肝功能恢复情况 ,再灌注 1h后检测肝细胞内游离钙 ([Ca2 + ]i)、ATP含量以及肝组织病理学变化。结果　维拉帕米预处理组 (实验组 )缺血再灌注后ALT、AST、[Ca2 + ]i升高不明显 ,明显低于对照组 (P <0 0 1)。实验组肝细胞内ATP降低不明显 ,组织病理学变化轻 ,术后肝功复常时间较短。结论　维拉帕米予处理对临床肝叶切除时缺血再灌注损伤有明显保护作用 ,将其用于肝叶切除有利于改善肝功能的保护。Objective To study the protective effect of verapamil against ischemia reperfusion injury when liver was resected.Methods The routine Pringle's maneuver hepatic vascular occlusion in 18～20min. Thirty-nine patients for resection of liver with cirrhosis were randomly divided into two groups, Verapamil group (n=20), the 20 patients with hepatectomy were given by 5mg verapamil through right gastroepiploic vein before blocking porta hepatis.Physiologic saline group (n=19), were injected by 20ml saline in the same way.The variation of postoperative liver function were measured.Liver intracellular [Ca 2+ ]i and adenosine triphosphate (ATP) after being reperfused for 1h were measured as well as the hepatic histopathologic alterations were also examined.Results The levels of intracellular [Ca 2+ ]i concentrations,alanine aminotransferase (ALT) and aspartate aminotransferase(AST)from the verapamil group increment less than those of the physiologic saline group(P<0 01),Meanwhile, hepatic cell ATP decrease slightly and the hepatic histopathologic alterations were significantly lessened as well as the hepatic function restored earlier in verapamil group.Conclutions Given verapamil by hepatic portal vein before blocking porta hepatis, which shows an important protective effect against hepatic ischemia-reperfusion injury for resection of liver and has benefit for recovery of patients.

关 键 词：肝脏 缺血预处理 缺血再灌注损伤 维拉帕米 

分 类 号：R657.3[医药卫生—外科学]