丙泊酚麻醉对肝切除肝缺血-再灌注损伤保护效应的Meta分析

Protective effect of propofol anesthesia on liver ischemia-reperfusion injury after hepatectomy:a Meta-analysis

目的系统评价丙泊酚麻醉对肝门阻断的肝切除术后肝缺血-再灌注损伤(IRI)的影响。方法检索PubMed、EMBASE、Web of Science、Cochane Library、中国知网、万方、维普科技期刊、中国生物医学文献等数据库,时间为建库至2019年12月。检索丙泊酚麻醉对肝切除术后肝IRI影响的随机对照研究,研究结局指标为血超氧化物歧化酶(SOD)、丙二醛(MDA)、ALT、AST。采用RevMan 5.3软件进行Meta分析。结果最终共纳入23篇文献,包括1317例患者,其中丙泊酚麻醉组(试验组)746例,非丙泊酚麻醉组(对照组)571例。Meta分析示:再开放15 min和30~45 min,试验组血SOD水平明显高于对照组(MD=15.08,24.20;P<0.05);而试验组血MDA水平明显低于对照组(MD=-5.73,-5.28;P<0.05)。再开放15 min,试验组血ALT和AST水平明显低于对照组(MD=-24.46,-23.85;P<0.05)。术后第1天,试验组血ALT水平明显低于对照组(MD=-32.75,P<0.05)。术后第3~4天,试验组AST水平亦明显低于对照组(MD=-10.03,P<0.05)。结论丙泊酚麻醉可能对肝切除IRI有一定的保护效应。

Objective To systematically evaluate the effect of propofol anesthesia on liver ischemia-reperfusion injury(IRI)after hepatectomy with hepatic portal occlusion.Methods Literature review was performed in databases of PubMed,EMBASE,Web of Science,Cochane Library,CNKI,Wanfang Data,VIP and SinoMed from inception to December 2019.The randomized controlled studies evaluating the effect of propofol anesthesia on liver IRI after hepatectomy were retrieved.The outcome indexes included superoxide dismutase(SOD),malondialdehyde(MDA),ALT and AST.Meta-analysis was performed using RevMan 5.3 software.Results A total of 23 articles,1317 patients were eventually included.746 cases received propofol anesthesia(study group)and 571 cases were given with non-propofol anesthesia(control group).Meta-analysis showed that after blood re-opening for 15 min and 30-45 min,the SOD level in the study group was significantly higher than that in the control group(MD=15.08,24.20;P<0.05),whereas the MDA level was significantly lower than that in the control group(MD=-5.73,-5.28;P<0.05).After re-opening for 15 min,the ALT and AST levels in the study group were significantly lower than those in the control group(MD=-24.46,-23.85;P<0.05).At postoperative 1 d,the ALT level in the study group was significantly lower than that in the control group(MD=-32.75,P<0.05).At postoperative 3-4 d,the AST level in the study group was also remarkably lower than that in the control group(MD=-10.03,P<0.05).Conclusions Propofol anesthesia probably exerts a protective effect upon liver IRI after hepatectomy.