摘要
目的探讨七氟烷吸入时机对肝脏部分切除术患者肝脏缺血再灌注损伤的影响。方法2013年7月~2017年7月我院收治的60例择期行肝脏部分切除术治疗的原发性肝癌(PLC)患者,按照七氟烷吸入时机的不同将其分为预处理、后处理和全程吸入组,每组20例。比较术前和术后7 d肝功能指标、血清超氧化物歧化酶(SOD)、血清脂质过氧化代谢产物丙二醛(MDA)、血清前白蛋白(PA)和C反应蛋白(CRP)水平及细胞因子水平,观察三组手术肝门阻断次数、阻断时间、手术时间、出血量和术后住院时间。结果在术后7 d时,预处理组、后处理组和全程吸入组血清ALT水平为分别为(56.7±6.2)U/L、(148.2±13.2)U/L和(95.2±15.2)U/L,差异显著(P<0.05),血清AST水平分别为(40.4±10.1)U/L、(184.5±12.5)U/L和(134.2±15.6)U/L,差异显著(P<0.05),血清TBIL水平分别为(29.8±6.7)μmol/L、(46.7±6.8)μmol/L和(35.1±6.7)μmol/L,差异显著(P<0.05),INR水平分别为(1.1±0.7)、(1.4±1.2)和(1.2±1.1),差异显著(P<0.05);MDA水平分别为(9.4±3.6)U/L、(19.7±6.5)U/L和(11.4±4.9)U/L,差异显著(P<0.05),SOD水平分别为(36.7±6.4)nmol/mL、(13.4±5.2)nmol/mL和(24.8±16.7)nmol/mL,差异显著(P<0.05),PA水平分别为(159.8±15.8)mg/L、(102.1±16.3)mg/L和(129.9±21.2)mg/L,差异显著(P<0.05),CRP水平分别为(29.3±1.2)mg/L、(44.8±3.5)mg/L和(33.6±1.6)mg/L,差异显著(P<0.05);IL-6水平分别为(16.3±2.3)pg/ml、(9.6±2.4)pg/ml和(4.2±1.6)pg/ml,差异显著(P<0.05),IL-10水平分别为(9.1±1.3)pg/ml、(5.2±2.5)pg/ml和(7.4±1.4)pg/ml,差异显著(P<0.05),TNF-α水平分别为(15.4±2.7)pg/ml、(42.3±3.5)pg/ml和(28.4±2.7)pg/ml,差异显著(P<0.05)。结论采用七氟烷预处理麻醉对行肝脏部分切除术的PLC患者肝脏缺血再灌注损伤具有显著的保护作用,值得进一步探讨。
Objective To investigate the effects of sevoflurane inhalation on hepatic ischemia-reperfusion injury(HIRI)in patients with primary liver cancer(PLC)undergoing partial hepatectomy.Methods 60 patients with PLC undergoing selective partial hepatectomy were recruited in this study between July 2013 and July 2017,and were randomly divided into pre-inhalation,post-inhalation and whole-course inhalation group,with 20 cases in each group according to the time of sevoflurane inhalation difference.All patients received partial hepatectomy.The indexes of liver function,serum superoxide dismutase(SOD),malondialdehyde(MDA),serum prealbumin(PA)and C reactive protein(CRP),and interleukin 6(IL-6),IL-10 and tumor necrosis factor-α(TNF-α)were measured and compared in the three groups.The blockage times of porta hepatis and block periods,the times of operation,the amounts of blood loss and hospital stay after operation were also recorded and compared.Results At the end of seven days after operation,serum ALT levels in pre-inhalation,post-inhalation and whole-course inhalation groups were(56.7±6.2)U/L,(148.2±13.2)U/L and(95.2±15.2)U/L,respectively(P<0.05),serum AST levels were(40.4±10.1)U/L,(184.5±12.5)U/L and(134.2±15.6)U/L,respectively(P<0.05),serum bilirubin levels were(29.8±6.7)μmol/L,(46.7±6.8)μmol/L and(35.1±6.7)μmol/L,respectively(P<0.05),INR were(1.1±0.7),(1.4±1.2)and(1.2±1.1),respectively(P<0.05);serum MDA levels were(9.4±3.6)U/L,(19.7±6.5)U/L and(11.4±4.9)U/L,respectively(P<0.05),SOD levels were(36.7±6.4)nmol/mL,(13.4±5.2)nmol/mL and(24.8±16.7)nmol/mL,respectively(P<0.05),PA levels were(159.8±15.8)mg/L,(102.1±16.3)mg/L and(129.9±21.2)mg/L,respectively(P<0.05),and CRP levels were(29.3±1.2)mg/L,(44.8±3.5)mg/L and(33.6±1.6)mg/L,respectively(P<0.05);serum IL-6 levels were(16.3±2.3)pg/ml,(9.6±2.4)pg/ml and(4.2±1.6)pg/ml,respectively(P<0.05),IL-10 levels were(9.1±1.3)pg/ml,(5.2±2.5)pg/ml and(7.4±1.4)pg/ml,respectively(P<0.05),and serum TNF-αlevels were(15.4±2.7)pg/ml,(42.3±3.5)pg/ml and(28.4±2.7)pg/ml,respectively(P<0.05).Conclusion The applicaton of sevoflurane pre-inhalation has efficacious protective effect on HIRI in PLC patients undergoing partial hepatectomy,which warrants further investigation.
作者
刘杏
赵树立
张殿隆
Liu Xing;Zhao Shuli;Zhang Dianlong(Department of Surgical Anesthesiology,First People's Hospital,Xianyang 712000,Shaanxi Province,China)
出处
《实用肝脏病杂志》
CAS
2019年第5期728-731,共4页
Journal of Practical Hepatology
基金
咸阳市科技局科技创新项目(编号：2015K02365)
