右美托咪定在左半肝切除术中对肝缺血再灌注损伤作用的分析

Effect of dexmedetomidin on hepatic ischemia-reperfusion injury in left hemihepatectomy

  • 摘要: 目的 分析右美托咪定在左半肝切除术中对肝缺血再灌注损伤的作用。 方法 选择本院2016年1月- 2017年12月60例行左半肝切除术的患者,随机分为实验组和对照组。实验组在麻醉诱导前给予右美托咪定,以1μg/(kg·h)的速度静脉泵入10 min,然后以0.5μg/(kg·h)的速度静脉持续泵入至手术结束。对照组予以同等剂量的0.9%氯化钠注射液。分别于肝门阻断前(T0)、肝门开放后(T1)、关腹前(T2)和术后第1天(T3)检测患者的肝功能和细胞因子水平。 结果 所有患者均顺利完成手术,实验组平均手术时间(243.6±59.1) min,肝门阻断时间(24.7±10.3) min。肝门阻断后,肝功能各项指标和白细胞介素-6(interleukin-6,IL-6)、IL-10、丙二醛(malondialdehyde,MDA)较阻断前逐渐上升,SOD逐渐下降(P均< 0.05)。术后第1天实验组肝功能指标谷丙转氨酶(alanine aminotransferase,ALT)、谷草转氨酶(aspartate aminotransferase,AST)、碱性磷酸酶(alkaline phosphatase,ALP)和总胆红素(total bilirubin,TB)均低于对照组ALT:(114.5±32.8) U/L vs (189.2±57.3) U/L;AST:(98.5±35.4) U/L vs (168.8±45.3) U/L;ALP:(206.5±78.3) U/L vs (297.7±116.4)U/L;TB:(20.8±6.2) μmol/L vs(24.9±8.3) μmol/L;P均< 0.05;实验组细胞因子指标IL-6和MDA分别为(176.5±28.7) pg/ml和(8.6±3.3) nmol/L,均低于对照组的(276.5±74.2) pg/ml和(15.4±5.3) nmol/L(P均< 0.05);实验组IL-10和超氧化物歧化酶分别为(15.8±3.1) pg/ml和(37.6±10.1) U/ml,均高于对照组的(9.2±3.4) pg/ml和(24.9±7.8) U/ml (P均< 0.05)。 结论 右美托咪定能减少氧自由基和促炎性细胞因子的产生,对肝缺血再灌注损伤具有一定的保护作用。

     

    Abstract: Objective To analyze the effect of dexmedetomidin on hepatic ischemia-reperfusion injury in left hemihepatectomy. Methods Clinical data about 60 patients who underwent left hemihepatectomy in the First Affiliated Hospital of Chinese PLA General Hospital from January 2016 to December 2017 were analyzed. Patients were randomly divided into experimental group and control group. The experimental group were injected with dexmedetomidine at 1μg/(kg·h) before anesthesia and lasted for 10 minutes. Then dexmedetomidine were injected at 0.5 μg/(kg ·h) until the end of the operation. The patients in the control group were injected with the same dosage of saline. The liver function and cytokines were compared between two groups at T0 (before hepatic portal occlusion), T1 (after hepatic portal opening), T2 (before abdominal incision closure) and T3 (first day after operation). Results All patients received the surgery successfully. The operating time was (243.6±59.1) min, and the hepatic portal occlusion time was (24.7±10.3) min in experimental group. After the occlusion of the hepatic portal, the indexes of liver function and IL-6, IL-10, MDA increased gradually compared with baseline, and the SOD decreased gradually (all P< 0.05). At 1 day after operation, ALT, AST, ALP and TB in experimental group were significantly lower than those in control group ALT, (114.5±32.8) U/L vs (189.2±57.3) U/L; AST, (98.5±35.4) U/L vs (168.8±45.3) U/L; ALP, (206.5±78.3) U/L vs (297.7±116.4) U/L; TB, (20.8±6.2) μmol/L vs (24.9±8.3) μmol/L; all P< 0.05, IL-6 and MDA of experimental group were (176.5±28.7) pg/ml and (8.6±3.3) nmol/L, which were significantly lower than that of control group (276.5±74.2) pg/ml and (15.4±5.3) nmol/L (P< 0.05, respectively). However, the IL-10 and SOD of experimental group were significantly higher than those of control group (15.8±3.1) pg/ml vs (9.2±3.4) pg/ml, (37.6±10.1) U/ml vs (24.9±7.8) U/ml, P< 0.05, respectively. Conclusion Dexme-detomidine can inhibit the formation of oxygen free radicals and reduce the production of proinflammatory cytokines, which can protect the liver function from ischemiareperfusion injury.

     

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