七氟醚对藏区肝部分切除术患者缺血再灌注损伤的影响

Effects of sevoflurane on liver ischemia-reperfusion injury in Tibetan patients undergoing hepatic hydatid surgery

目的探讨七氟醚预处理对藏区肝包虫手术患者肝缺血再灌注损伤(LIRI)和血浆中性粒细胞核转录因子κB(NF-κB)活性的影响。方法选择就诊的80例肝包虫手术患者,采用随机数字表法将其随机分为藏族世居包虫患者对照组(ZC组)、藏族世居包虫患者七氟醚预处理组(ZS组)、汉族移居包虫患者对照组(HC组)和汉族移居包虫患者七氟醚预处理组(HS组)各20例。ZC组和HC组不用吸入性麻醉药,ZS组和HS组麻醉诱导插管采用七氟醚吸入麻醉。于麻醉诱导前(T0)、肝门阻断即刻(T1)、肝门开放即刻(T2)、缺血/再灌注1 h(T3)、6 h(T4)、24 h(T5),检测各时刻血清丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)、乳酸脱氢酶(LDH)、乳酸、肿瘤坏死因子α(TNF-α)、白细胞介素(IL)-6水平和中性粒细胞NF-κB活性;于T3时刻,检测正常肝组织丙二醛(MDA)和超氧化物歧化酶(SOD)水平;HE染色光镜下观察肝组织病理学形态。结果与ZC组比,ZS组患者在T1~T5时间点的ALT、AST、LDH、乳酸、TNF-α、IL-6水平和NF-κB活性均降低(P<0.05),在T3时间点肝组织的SOD活性升高(P<0.05),肝组织的MDA水平降低(P<0.05);与HC组比,HS组患者在T1~T5时间点的ALT、AST、LDH、乳酸、TNF-α、IL-6水平和NF-κB活性均降低(P<0.05),在T3时间点肝组织的SOD活性升高(P<0.05),肝组织的MDA水平降低(P<0.05);HE染色显示ZS组和HS组肝组织病理变化减轻。结论七氟醚可能通过抑制中性粒细胞NF-κB活性,抑制炎症因子的释放,减轻藏区肝包虫手术患者肝缺血再灌注损伤。

Objective To investigate the effects of sevoflurane preconditioning on liver ischemia-reperfusion injury(LIRI)and plasma neutrophil nuclear transcription factor B(NF-κB)activity in Tibetan patients undergoing hepat-ic hydatid surgery.Methods 80 patients undergoing hepatic hydatid surgery were enrolled and were randomly di-vided into Tibetan generation living hydatid patient control group(group ZC),Tibetan generation living hydatid pa-tient sevoflurane preconditioning group(group ZS),Han immigrant living hydatid patient control group(group HC)and Han immigrant living hydatid patient sevoflurane preconditioning group(group HS)by random number table method,20 cases in each group.Group ZC and HC were not given any inhaled anesthetics.Group ZS and HS were given sevoflurane inhalation anesthesia for anesthesia-induced intubation.Before anesthesia induction(T0),imme-diate after porta hepatis occlusion(T1),immediate after porta hepatis opening(T2),at 1 h after ischemia/reperfu-sion(T3),at 6 h after ischemia/reperfusion(T4)and at 24 h after ischemia/reperfusion(T5),the levels of serum Alanine transaminase(ALT),aspartate transaminase(AST),lactic dehydrogenase(LDH),lactic acid,tumor nec-rosis factorα(TNF-α),interleukin6(IL-6)and neutrophil NF-κB activity at any time point were detected.Ma-londialdehyde(MDA)and superoxide dismutase(SOD)levels in normal liver tissues were detected at T3.Patholog-ical morphology of liver tissues was observed by HE staining under light microscope.Results Compared with group ZC,the levels of ALT,AST,LDH,lactic acid,TNF-αand IL-6,and NF-κB activity decreased in group ZS at T1~T5(P<0.05),while SOD activity of liver tissue increased at T3(P<0.05),and MDA level of liver tissue de-creased(P<0.05).Compared with group HC,the levels of ALT,AST,LDH,lactic acid,TNF-αand IL-6,and NF-κB activity decreased in group HS at T1~T5(P<0.05),while SOD activity of liver tissue increased at T3(P<0.05),and MDA level of liver tissue decreased(P<0.05).HE staining showed that pathological changes of liver tissue in group ZS and HS were alleviated.Conclusion Sevoflurane may alleviate LIRI in Tibetan patients undergoing hepatic hydatid surgery by inhibiting neutrophils NF-κB activity and the release of inflammatory factors.