丙泊酚-瑞芬太尼对肝脏缺血再灌注损伤的影响

Influence of Propofol-remifentanil on Hepatic Ischemia-Reperfusion Injury

目的探讨丙泊酚-瑞芬太尼对肝脏缺血再灌注损伤的保护作用以及作用机制。方法 2009年6月-2011年12月选择择期需阻断肝门的肝脏手术患者40例,随机分为丙泊酚-瑞芬太尼组(P组)和异氟醚组(I组),每组20例。在术前(T0)和肝门阻断开放后30 min(T1)、60 min(T2)、6 h(T3)、24 h(T4)、72 h(T5)分别抽取动脉血,测定天冬氨酸氨基转移酶(AST)、丙氨酸氨基转移酶(ALT)和肿瘤坏死因子α(TNF-α)的含量。结果两组AST、ALT、TNF-α较术前均有增高,差异有统计学意义(P<0.05);P组增高幅度明显低于I组,差异有统计学意义(P<0.05)。结论丙泊酚-瑞芬太尼对肝脏缺血再灌注损伤具有保护作用,抑制TNF-α的产生可能为其作用机制之一。

Objective To study the protection effect of propofol-remifentanil on hepatic ischemia-reperfusion injury and its possible mechanisms. Methods Forty patients needed to undergo the surgery of blocking liver porta between June 2009 and December 2011. They were randomly divided into the propofol-remifentanil group （P group） and isoflurane group （I group）, with 20 patients in each. Arterial blood was collected and its aspartate aminotransferase （AST）, alanine aminotransferase （ALT） and TNF-ct levels were measured before surgery （To）, and 30 minutes （T1）, 60 minutes （T2） and 6 hours （T3）, one day （T4）, and 3 days （Ts） after portal triad clamping and opening. Results AST, ALT and TNF-ct levels raised in both groups after operation （P 〈 0.05）. The changing level for patients in the P group was significantly higher than that for patients in the I group （P 〈 0.05）. Conclusion Propofol-remifentanil can protect the liver with hepatic ischemia- reperfusion injury, and the inhibition of TNF-ct production may be one of the mechanisms.