甘露醇对肝叶切除术患者红细胞醛糖还原酶、血浆一氧化氮和丙二醛水平的影响

Effects of mannitol on erythrocyte aldose reductase activity, plasma nitric oxide and malondialdehyde con- centrations in patients undergoing hepatolobectomy

目的探讨甘露醇对肝叶切除术患者红细胞醛糖还原酶（AR）活性、血浆一氧化氮（NO）和丙二醛（MDA）浓度的影响。方法择期行肝叶切除术患者40例，性别不限，年龄24～60岁，体重50～68kg，ASA分级Ⅰ或Ⅱ级，采用随机数字表法，将其随机分为2组（n=20）：生理盐水对照组（c组）和甘露醇组（M组）。2组均采用硬膜外复合全麻。术中阻断肝门即刻开始静脉输注20％甘露醇1．5ml／kg，经30min输完，c组给予等容量生理盐水。分别于麻醉前（基础状态）、肝门开放前即刻、术毕、术后1d、术后3d（T0-4）时采集静脉血样，测定红细胞AR活性、血浆NO和MDA浓度。结果与c组比较，M组L1,2时AR活性及血浆MDA浓度降低，血浆NO浓度升高（P〈0．05）。结论甘露醇可降低肝叶切除术患者肝缺血再灌注损伤，其机制与清除氧自由基，抑制脂质过氧化反应有关。

Objective To investigate the effects of mannitol on the activity of erythrocyte aldose reductase （AR）, plasma nitric oxide （NO） and malondialdehyde （MDA） concentrations in patients undergoing hepatolobee- tomy. Methods Forty ASA Ⅰ or Ⅱ patients （aged 24-63 yr and weighing 50-68 kg）, receiving combined general and epidural anesthesia and undergoing selective hepatolobectomy, were randomly assigned into a mannitol group （group M） and a normal saline group （group C）. During hepatic portal occlusion, normal saline 1.5 ml/kg and 20% mannitol 1.5 ml/kg were intravenously infused in groups C and M respectively for 30 rain. Venous blood samples were collected to measure the erythrocyte AR activity and plasma NO and MDA concentrations at the following time points ： before anesthesia induction （ T0 ）, at the end of hepatic portal occlusion （T1）, at the end of operation （T2） , one day after operation （T3 ） and three days after operation （ T4 ） , respectively. Results Compared with group C at T1,2, the erythrocyte AR and plasma MDA concentration decreased while plasma NO concen- tration increased in group M （ P 〈 0.05）. Conclusion Mannitol can reduce hepatic ischemia and reperfusion injury in patients undergoing hepatolobectomy, which may be related to the mechanism of mannitol removing oxygen- derived free radicals and inhibiting lipid peroxidation.