预先吸入七氟醚对肝脏缺血再灌注损伤及免疫功能的影响

Effect of sevoflurane pre-inhalation on liver ischemia-reperfusion injury and immune function

目的研究预先吸入七氟醚对肝部分切除术肝脏缺血再灌注损伤及术后免疫功能的影响。方法将60例接受肝部分切除术的患者随机分为2组,七氟醚组行预先吸入七氟醚复合静脉麻醉,对照组行全凭静脉麻醉,检测2组患者血清中肝功能指标、肝脏组织中氧化应激指标和凋亡分子、外周血中免疫分子。结果缺血再灌注后2 h(T_2)、6 h(T_3),七氟醚组患者血清中丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)、谷氨酸脱氢酶(GLDH)、α-谷胱甘肽-S转移酶(α-GST)的含量低于对照组(P<0.05);七氟醚组肝脏组织中过氧化物酶VI(Prx VI)、超氧化物歧化酶(SOD)、过氧化氢酶(CAT)含量高于对照组(P<0.05),丙二醛(MDA)、终末氧化蛋白产物(AOPP)以及凋亡分子Bax、Caspase-3含量低于对照组(P<0.05);七氟醚组患者外周血中CD4+T细胞含量以及CD4+T细胞/CD8+T细胞比例高于对照组(P<0.05),CD8+T细胞含量低于对照组(P<0.05)。结论预先吸入七氟醚能够减轻机体氧化应激反应、抑制凋亡分子表达,减轻肝脏缺血再灌注损伤,提高细胞免疫功能,是肝部分切除术较好的麻醉方法。

Objective To study the effect of sevoflurane pre -inhalation on liver ischemia -reperfusion injury in partial liver resection and post - operative immune function. Methods 60 patients received partial liver resection were randomly divided into two groups, sevoflurane group received sevoflurane pre - inhalation combined with introvenous anesthesia, controlled group received totally in- trovenous anesthesia. Then serum biochemical indicators of liver damage, oxidative stress and apoptosis molecules in liver tissue, immune molecules in peripheral blood of two groups were compared. Results Immediate ischemia and reperfusion 2h （ T2 ）, 6h （ T3 ）, serum ALT, AST, GLDH, ct - GST contents of sevoflurane group were lower than the control group （ P 〈 0.05 ）. PrxVI, SOD, CAT contents in liver tissue of sevoflurane group were higher than the control group （ P 〈 0.05 ）, oxidative stress product MDA, AOPP and apoptotic mole- cule Bax, Caspase - 3 contents were lower than the control group （ P 〈 0.05 ）. CD4 plus T cell levels and CD4 plus T cells/CD8 plus T cell ratio in peripheral blood of sevoflurane group were higher than the control group （ P 〈 0.05 ）, CD8 plus T cell levels were lower than the control group （ P 〈 0.05 ）. Conclusion Sevoflurane pre - inhalation can reduce hepatic ischemia - reperfusion injury, relieve oxida- tive stress and inhibit the expression of apoptotic molecules. It can also improve immune function. It＇ s a better anesthesia method for par- tial liver resection.