七氟醚预先吸入在右肝切除术中对肝脏缺血/再灌注损伤的保护作用

Protective effects of sevoflurane pre-inhalation on hepatic ischemia reperfusion injury in the right hepatectomy

目的探讨七氟醚预先吸入在右肝切除术中对肝脏缺血/再灌注损伤的保护作用及其机制。方法择期全麻下行右肝癌切除术患者40例,ASAⅠ或Ⅱ级,术中经第一肝门阻断,血流阻断时间10～30min,随机分为2组(n=20):缺血/再灌注组(IR组)和七氟醚预先吸入组(S组)。两组麻醉维持期间均保持脑电双频谱指数40～50。S组麻醉诱导后吸入1.0最低肺泡有效浓度(MAC)七氟醚,30min后洗脱15min。于麻醉诱导前(T0)、缺血/再灌注即刻(T1)、1h(T2)、6h(T3)测血清中谷丙转氨酶(ALT)、谷草转氨酶(AST)、乳酸脱氢酶(LDH)的含量以及肝组织匀浆中丙二醛(MDA)含量和超氧化物岐化酶(SOD)活性,并行肝组织病理学观察。结果与麻醉诱导前比较,两组患者缺血/再灌注即刻、1、6h血清ALT、AST、LDH含量均显著增加(P<0.05);与IR组比较,S组缺血/再灌注后相应各时点血清ALT、AST、LDH含量均降低,肝组织匀浆MDA含量减少,SOD活性增加(P<0.05);肝组织病理学损伤减轻。结论七氟醚预先吸入对右肝切除患者肝脏缺血/再灌注损伤有保护作用,可能与其抑制氧自由基生成,减少脂质过氧化有关。

Objective To investigate the protection and mechanism of sevoflurane pre-inhalation on hepatic ischemia reperfusion injury in the right hepatectomy.Methods Forty ASA Ⅰ or Ⅱ patients under general anesthesia for right liver cancer operation in the technique blocks after the first liver gate,hepatic inflow occlusion time 10～30 min,were allocated randomly into 2 groups（n=20）：ischemia reperfusion group（group IR）,sevoflurane pre-inhalation group（group S）.During maintenance of anesthesia,BIS value was maintained at 40~50 in both groups.In group S patients inhales 1.0 MAC sevoflurane for 30 min followed by 15 min of wash-out after induction of anestheia.Serum levels of alanine aminotransferase（ALT）,aspartate aminotransferase（AST）and lactate dehydrogenase（LDH）were determined before induction of anestheia（T0）,immediated ischemia-reperfusion（T1）,at 1 h（T2）and 6 h（T3）after ischemia-reperfusion.Malondialdehyde（MDA）content and superoxide dismutase（SOD）activities in liver tissue homogenate were measured,and histopathological changes of liver were observed.Result Compared to before induction of anestheia,the levels of serum ALT,AST,and LDH in both groups of immediated ischemia-reperfusion,at 1 h and 6 h after ischemia-reperfusion were significantly higher;As compared to those of IR group,the serum levels of ALT,AST,LDH,and the content of MDA in liver tissue homogenate of the S group were lower,and the activities of SOD was higher（P〈0.05）,pathology injury of hepatic tissue in the S group were reduced.Conclusion Sevoflurane pre-inhalation can protect right liver operation from ischemia-reperfusion injury.The protective mechanisms may relate to reduceing the release of oxyradical and inhibiting the lipid peroxidation.