鞘内注射瑞芬太尼对肝缺血再灌注影响研究

Intrathecal pretreatment with remifentanil on hepatic ischemia reperfusion

目的探讨鞘内注射瑞芬太尼对肝缺血再灌注的影响。方法将成年雄性C57/6J小鼠随机分为对照组(sham组,n=3),缺血再灌注组(I/R组,n=8)及瑞芬太尼预处理组(RPC组,n=16),其中,RPC组根据瑞芬太尼的剂量再分为RPC1组(剂量为25.0μg/kg,n=8)与RPC2组(剂量为2.5μg/kg,n=8)。除sham组外,其余各组均建立肝70%缺血再灌注模型,即肝缺血45 min后再灌注2 h。检测血清丙氨酸转氨酶(ALT)与天冬氨酸转氨酶(AST)水平,观察肝组织病理改变与细胞凋亡。结果 RPC1组与RPC2组的ALT与AST均低于I/R组,差异有统计学意义(P<0.05)。I/R组肝组织中央静脉、肝窦扩张淤血,汇管区大量炎性细胞浸润,肝细胞大量死亡,部分肝组织结构破坏;RPC2组大部分肝细胞形态完整,偶可见点状坏死,有轻微炎性细胞浸润,肝小叶结构完整。I/R组可见大量胞核棕黄色的阳性细胞分布于汇管区,染色阳性细胞比例为(5.70%±0.89%);RPC2组可见少量凋亡肝细胞分布,染色阳性细胞比例为(2.00%±0.68%),差异有统计学意义(P<0.05)。结论鞘内注射瑞芬太尼可减轻肝缺血再灌注损伤。

Objective To investigate the effect of intrathecal pretreatment with remifentanil on hepatic ischemia reperfusion.Methods Healthy adult C57/6J rats were randomly divided into the control group（sham group,n=3）,ischemic reperfusion group（I/R,n=8） and remifentanil pretreatment group（RPC group,n=16）.Based on the doses of remifentanil,the RPC group was further divided into 2 subgroups： RPC1 group（25.0 μg/kg,n=8） and RPC2 group（2.5 μg/kg,n=8）.The rats model of segmental（70%） hepatic ischemia reperfusion were established in all groups except the sham group,which were subjected to ischemia for 45 minuts and reperfusion for2 hours.Serum levels of alanine aminotransferase（ALT） and aspartate amino transferase（AST） were detected,the pathological changes of liver tissues and apoptosis were observed.Results Compared to I/R group,serum ALT and AST were significantly reduced in PRC1 and RPC2 groups（P0.05）.In I/R group,there was dilation and congestion of liver tissue central vein and hepatic sinus,large number of inflammatory cell infiltration in the manifold area,mass death of liver cells,partial liver tissue structure destruction.Most hepatic cell morphology in RPC2 group was complete,with occasional point necrosis,mild inflammatory cell infiltration,and complete liver lobular structure.In the I/R group,a large number of positive cells were found to be distributed in the sink area,and the proportion of the positive cells was（5.70% ± 0.89%）.In RPC2 group,the distribution of apoptotic hepatocytes was observed,and the ratio of staining positive cells was（2.00% ± 0.68%）,and the difference was statistically significant（P0.05）.Conclusion Intrathecal pretreatment with remifentanil can reduce the damage of hepatic ischemia reperfusion.CUI Cui, YANG Li-qun （ Department of Anesthesiology, Eastern Hepatobiliary Surgery Hospital, The Affiliated Hospital of Second Mili- tary Medical University, Shanghai 200438, China）