异丙酚麻醉对围术期肝脏缺血再灌注损伤的保护作用

The mechanism of hepatic ischemic-reperfusion injury and protective effects of propofol during peri-operation of partial hepatectomy

目的观察围术期应用异丙酚麻醉对肝脏缺血再灌注损伤时的中性粒细胞黏附因子的影响。方法需阻断肝门择期肝脏手术病人40例,随机分为对照组(采用咪唑安定、芬太尼、阿曲库胺麻醉诱导)与试验组(静注异丙酚2mg/kg,余同对照组)。两组均静注芬太尼、阿曲库胺间断维持麻醉,试验组加注异丙酚4～6mg/(kg·h)持续静注至关腹,对照组输注等量生理盐水。采用流氏细胞仪测定不同时间点的血中性粒细胞黏附因子(CD11b)表达量。并于肝门阻断前、开放后30分钟、60分钟取无瘤肝组织采用RT-PCR方法测细胞间黏附因子-1(ICAM-1)基因表达。结果两组CD11b于肝门开放后逐渐升高,于开放后60分钟时较术前升高显著(P<0.05),120分钟达高峰(P<0.01);在60～120分钟时间点对照组明显高于试验组(P<0.05)。肝门开放30分钟后,两组肝脏组织中的ICAM-1mRNA表达量略有升高,60分钟时试验组较对照组表达量降低,但组间差异不显著(P>0.05)。结论异丙酚通过降低中性粒细胞黏附因子含量与活性,对肝脏围术期缺血再灌损伤产生一定保护作用。

Objective To observe the protective effects of propofol on the hepatic ischemic-reperfusion injury(HIRI) during normothermic partial hepatectomy.Methods Forty patients undergoing elective partial hepatectomy in normothermic status were divided into two groups randomly.Observe group:the propofol solution were perfused intravenous continuously from the beginning of induction to the peritoneal suturing with the rate of 4mg/(kg·h).Control group:the propofol infusion were substituted with normal saline by equivalence method.Venous blood samples were taken at different time points separatively as to measure the concentrations CD11b by flow cytometry.Meanwhile,the hepatic tissues were taken at preoperative,10min and 30min after HIRI to analyse the genes expression of ICAM-1 by RT-PCR.Results The expression of CD11b at 30,60,120min were higher than that of preoperative in both groups ,but it was lower in the observe group than that of control group at the same times(P<0.01).The expression of ICAM-1 mRNA was notdifference significantly between two groups at any time(P>0.05).Conclusion It seems that propofol is an available protective agent during normothermic partial hepatectomy as to relieve the hepatic ischemic-reperfusion injury by inhibiting the activation of PMN.