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| 七氟醚预处理对高原地区肝包虫手术肝缺血-再灌注损伤的作用 |
| Effects of sevoflurane pretreatment on hepatic ischemia-reperfusion injury during hepatic hydatid surgery at high altitude |
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| DOI：10.12089/jca.2019.11.004 |
| 中文关键词: 七氟醚 肝包虫病 缺血-再灌注损伤；核因子-κB；细胞间黏附分子-1 |
| 英文关键词: Sevoflurane Hepatic echinococcosis Ischemia reperfusion injury NF-κB ICAM-1 |
| 基金项目:青海省基础研究计划项目(2017-ZJ-758) |
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| 中文摘要: |
目的 探讨七氟醚预处理对减轻高原地区肝包虫患者缺血-再灌注损伤的作用,进而为肝包虫病手术中合理用药提供理论依据。
方法 选取2017年9月至2018年7月本院收治的泡型肝包虫手术患者50例,男27例,女23例,年龄22～68岁,体重40～90 kg,ASA Ⅰ或Ⅱ级,Child-Pugh分级A级。随机分为七氟醚预处理组(SEV组)与对照组(TIVA组)。SEV组持续性吸入2％的七氟醚,于手术结束前30 min停止。TIVA组给予全凭静脉麻醉,采用瑞芬太尼0.2 μg·kg-1·min-1和丙泊酚1.5～2.5 μg/ml靶控输注,间接追加顺式阿曲库铵。记录麻醉诱导前(T0)、肝门阻断(T1)、肝门开放(T2)、缺血-再灌注1 h(T3)、6 h(T4)、24 h(T5)两组患者ALT、AST、乳酸(Lac)、肿瘤坏死因子-α(TNF-α)、白细胞介素-1(IL-1)浓度,检测肝组织丙二醛(MDA)、超氧化物歧化酶(SOD)活性和NF-κB、ICAM-1蛋白相对含量,观察两组患者术中出血量、拔管时间、下床活动时间、术后住院时间、肝衰竭发生等情况。结果T2—T5时,SEV组ALT、AST、Lac、MDA、TNF-α、IL-1明显低于TIVA组(P<0.05),NF-κB和ICAM-1蛋白相对含量明显低于TIVA组(P<0.05),SOD活性明显强于TIVA组(P<0.05)。SEV组患者术中出血量明显少于TIVA组(P<0.05),术后住院时间、下床活动时间明显短于TIVA组(P<0.05),肝衰竭发生率明显低于TIVA组(P<0.05)。
结论 七氟醚预处理可减轻高原地区肝包虫手术肝缺血-再灌注损伤,可能与减少炎性因子生成、增强肝脏自由基清除能力有关。 |
| 英文摘要: |
Ojective To explore the effect of sevoflurane pretreatment on alleviating ischemia-reperfusion injury in patients with hepatic echinococcosis at high altitude, and to provide theoretical basis for rational drug use in hepatic echinococcosis surgery.
Methods Fifty patients underwent alveolar hepatic hydatid surgery in our hospital from September 2017 to July 2018 were selected, 27 males and 23 females, aged 22-68 years, weighing 40-90 kg, falling into ASA physical status Ⅰ-Ⅱ and Child-Pugh A. They were randomly divided into group sevoflurane pretreatment (group SEV) and group control (group TIVA). Group TIVA was given total intravenous anesthesia with target-controlled infusion of remifentanil 0.2 μg·kg-1·min-1 and propofol 1.5-2.5 μg/ml and indirect addition of cis-atracurium, group SEV inhaled 2％ sevoflurane continuously at the same time and stopped 30 minutes before the end of the operation. Alanine aminotransferase (ALT), aspartate aminotransferase (AST), lactate (Lac), tumor necrosis factor-α (TNF-α), interleukin-1 (IL-1) were measured at these points in time: before induction of anesthesia (T0), hepatic hilar block (T1), hepatic hilar opening (T2), ischemia-reperfusion 1 h (T3), 6 h (T4) and 24 h (T5). And malondialdehyde (MDA) concentration, superoxide dismutase (SOD) activity and relative content of NF-κB and ICAM-1 protein in liver tissue were also detected. Intraoperative blood loss, the hospital stay, ambulation time, incidence of liver failure and extubation time were observed.
Results The concentrations of ALT, AST, Lac, MDA, TNF-α and IL-1 in group SEV at T2-T5 were significantly lower than those in group TIVA (P < 0.05). Relative content of NF-κB and ICAM-1 protein in group TIVA were significantly lower than that in group TIVA (P < 0.05), SOD activity was significantly stronger than group TIVA (P < 0.05). Intraoperative blood loss, the hospitalization time, time to get out of bed and the incidence of liver failure in group SEV were significantly lower than those in group TIVA (P < 0.05).
Conclusion Sevoflurane preconditioning can alleviate hepatic ischemia-reperfusion injury during hepatic hydatid surgery at high altitude, which may be related to reducing the production of inflammatory factors and enhancing the ability of free radical scavenging in the liver. |
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