维拉帕米联合乌司他丁预处理对肝脏切除术缺血-再灌注损伤的防护作用

Observation on Protective Effects of Verapamil Combined with Ulinastatin Pretreatment on Ischemia Reperfusion Injury in Liver Resection

目的探讨维拉帕米联合乌司他丁在肝脏叶段切除术前预处理对术后肝脏功能的保护作用。方法将肝胆外科2012年1月至2014年10月收治的行肝叶段切除的占位病变患者82例随机分为观察组42例和对照组40例。手术采用Pringle间歇肝门阻断法,对照组肝门阻断前经胃网膜右静脉推注乌司他丁注射液,观察组在对照组基础上联合使用维拉帕米注射液。肝门阻断前与血液复灌1 h后切取少许健康肝组织测定三磷酸腺苷(ATP)与游离钙离子(Ca2+)浓度,术后每日监测肝转氨酶水平。结果两组患者术后早期转氨酶均较术前明显升高,而后呈逐步下降趋势;观察组患者术后1,3,5 d的丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)水平均明显低于对照组(P<0.05);血流复灌后,观察组ATP水平略有下降,对照组明显下降,组间比较,差异有统计学意义(P<0.05);两组患者游离Ca2+浓度均明显上升,观察组明显低于对照组(P<0.05)。结论乌司他丁与维拉帕米在肝脏叶段切除术肝门阻断前预处理,二者作用协同,较单用乌司他丁能维持相对稳定的肝内能量代谢,进一步降低术后肝功能损害。

Objective To investigate the protective effects of verapamil combined with ulinastatin pretreatment on postoperative liver function in liver lobe resection. Methods 82 cases of liver space-occupying lesion undergoing liver lobe resection in the hepatobiliary surgical department from January 2012 to October 2014 were randomly divided into the observation group（42 cases） and the control group（40 cases）. The operation adopted the Pringle intermittent hepatic portal blocking method. The control group was injected with uli-nastatin through the right gastroepiploic vein before hepatic portal blocking,while on this basis the observation group was combined the use of verapamil injection. A little healthy liver tissue was taken before the hepative portal blocking and at 1 h after blood reperfusion, and the ATP and free calcium ion （Ca2＋） concentration of liver tissue were determined. The postoperative hepatic transaminase levels were daily monitored. Results The early postoperative transaminase levels in the two groups were significantly increased compared with those before operation,then declined gradually;the ALT,AST values on postoperative 1,3,5 d in the observation group were significantly lower than those in the control group,the differences were statistically significant（ P 〈 0. 05）;after blood reperfusion,the ATP level in the observation group was slightly decreased,while that in the control group was decreased significantly,the difference between the two groups was statistically significant（ P 〈 0. 05）;the free Ca2 ＋ concentration in the two groups was significantly increased,but the ob-servation group was significantly lower than the control group（ P 〈 0. 05）. Conclusion The pretreatment of ulinastatin and verapamil before hepatic portal blocking in live lobe resection has the synergistic effect,which can maintain a relative stability of liver energy metabolism and further reduces the postoperative liver damage than single use of ulinastatin.