七氟醚预处理对右肝癌切除患者肝脏缺血再灌注损伤的保护作用

Protective Effects of Sevoflurane Preconditioning on the Right Liver Cancer Ischemia Reperfusion Injury

目的：探讨七氟醚预处理对右肝癌切除患者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手术切除患者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）和七氟醚预处理组（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1MAC七氟醚（呼气末浓度）．30min后洗脱15min。于麻醉诱导前（T0）、缺血再灌注即刻（T1）、1h（T2）、6h（T3）抽血测血清中谷丙转氨酶（ALT）．谷草转氨酶（AST），乳酸脱氢酶（LDH）的含量以及肝脏组织匀浆中丙二醛（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．两组缺血再灌注即刻．1h、6h血清ALT．AST，LDH含量均显著增加（P〈0．05）；与IR组比较，s组肝脏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：七氟醚预处理对右肝癌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 preconditioning on right liver cancer ischemia reperfusion injury. Methods：Forty ASA I or II patients for right liver cancer operation in the technique blocks after the first liver gate,hepatic inflow occlusion time 10-30min, were allocated randomly into 2 group （n=20）：ischemia reperfusion group （group IR） ,sevoflurane preconditioning group （group S）. During maintenance of anesthesia, BIS value was maintained at 40-50 in both groups. In group S patients inhales 1MAC 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-reper/usion （T1） ,at 1h （T2） and 6h （T3） after ischemia-reperfusion. Superoxide dismutase （SOD） activities and malondialdehyde （MDA） content in liver tissue were measured,and histopathological changes of liver were determined. Results：As compared to before induction of anestheia, the levels of serum ALT, AST, and LDH in both groups immediated ischemia-reperfusion,at lh and 6h 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 of the S group were lower, and the content of SOD was higher（P 〈0.05）,the abnormal changesof themorpho/ogy of hepatocyte in the S group were reduced. Conclusion：Sevoflurane preconditioning can protect right liver caner from ischemia and reperfusion injury. The protective mechanisms maybe related to reduceing the release of oxyradical and inhibiting the lipid peroxidation.