右美托咪定预处理对肝癌切除手术患者的肝缺血再灌注损伤的价值

Value of dexmedetomidine preconditioning on hepatic ischemia-reperfusion injury in patients undergoing hepatectomy for liver cancer

目的探讨右美托咪定(Dex)预处理对于肝癌切除手术患者的肝缺血再灌注损伤的影响。方法前瞻性选取辽宁省朝阳市第二医院拟实施半肝切除手术治疗的95例原发性肝细胞癌患者作为研究对象,采用随机数字表法分为预处理组48例和常规组47例,预处理组手术前给予Dex 0.7μg/kg,10 min内输注完毕,后以0.4μg/(kg·h)维持至手术结束,常规组给予等量的0.9%氯化钠溶液。比较2组患者的手术时间、术中出血量、输血率、肝血流阻断时间及手术并发症。比较2组患者手术前、手术后24 h的血清丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)、谷氨酰转肽酶(GGT)、总胆红素(STB)、结合胆红素(CB)、丙二醛(MDA)、超氧化物歧化酶(SOD)、肿瘤坏死因子-α(TNF-α)、C反应蛋白(CRP)、高迁移率族蛋白B1(HMGB1)、白细胞介素-6(IL-6)水平。结果 2组患者的手术时间、术中出血量、输血率、肝血流阻断时间比较,差异均无统计学意义(P> 0.05)。术前,预处理组和常规组患者的血清ALT、AST、GGT、STB、CB检测值比较,差异均无统计学意义(P> 0.05);术后24 h,预处理组患者的ALT、AST、GGT、STB、CB分别为(330.2±104.0) U/L、(367.1±110.8) U/L、(31.75±7.25) U/L、(65.20±11.35)μmol/L、(37.67±6.29)μmol/L,均低于常规组[(418.6±120.7) U/L、(440.8±127.6) U/L、(38.00±9.52) U/L、(74.18±13.37)μmol/L、(42.52±8.06)μmol/L],差异均有统计学意义(P <0.05)。术前,预处理组和常规组患者的血清MDA、SOD、TNF-α、CRP、HMGB1、IL-6检测值比较,差异均无统计学意义(P> 0.05);术后24 h,预处理组患者的血清MDA、TNF-α、CRP、HMGB1、IL-6分别为(4.36±1.33)μmol/L、(5.20±1.64)μg/L、(34.75±6.83) mg/L、(258.4±41.7)μg/L、(31.28±9.50)μg/L,均低于常规组[(5.11±1.57)μmol/L、(7.00±2.17)μg/L、(43.80±8.53) mg/L、(295.0±46.4)μg/L、(48.64±11.57)μg/L],预处理组的血清SOD[(126.9±25.0) U/L]高于常规组[(113.1±19.6) U/L],差异均有统计学意义(P <0.05)。预处理组患者的手术并发症发生率(12.50%)与常规组(21.28%)比较,差异无统计学意义(P> 0.05)。结论原发性肝细胞癌患者实施半肝切除手术时,术前Dex预处理能显著减轻肝缺血再灌注损伤,保护肝脏功能。

Objective To explore the effect of dexmedetomidine(Dex) pretreatment on liver ischemia-reperfusion injury in patients undergoing liver cancer resection. Methods Ninety-five patients undergoing hemihepatectomy in the Second Hospital of Chaoyang City Liaoning Province were prospectively selected as the research objects,and they were divided into the pretreatment group using a random number table method 48 cases and 47 cases in the conventional group. the pretreatment group was given Dex 0. 7 μg/kg before the operation,the infusion was completed within 10 minutes,and 0. 4 μg/(kg·h) maintained until the end of the operation,the conventional group was given the same amount of normal saline. The operation time,intraoperative blood loss,blood transfusion rate,hepatic blood flow block time,and surgical complications were compared between the two groups. The serum alanine transaminase(ALT),aspartic transaminase(AST),glutamyl transpeptidase(GGT),total bilirubin(STB),conjugated bilirubin(CB),malondialdehyde(MDA),superoxide dismutase(SOD),tumor necrosis factor-α(TNF-α),C-reactive protein(CRP),high mobility group protein B1(HMGB1),interleukin-6(IL-6) before and 24 hours after the operation were compared between the two groups of patients were compared. Results There was no statistically significant difference in the operation time,intraoperative blood loss,blood transfusion rate,and hepatic blood flow block time between the two groups of patients(P > 0. 05). Before operation,the serum ALT,AST,GGT,STB,CB test values of the pretreatment group and the routine group were compared,and there was no significant difference(P > 0. 05);24 h after the operation,the ALT,AST,GGT,STB,CB of the pretreatment group were(330. 2 ± 104. 0) U/L,(367. 1 ±110. 8) U/L,(31. 75 ± 7. 25) U/L,(65. 20 ± 11. 35) μmol/L,(37. 67 ± 6. 29) μmol/L,which were lower than the conventional group[(418. 6 ± 120. 7) U/L,(440. 8 ± 127. 6) U/L,(38. 00 ± 9. 52) U/L,(74. 18 ± 13. 37) μmol/L,(42. 52 ± 8. 06) μmol/L],the differences were statistically significant(P < 0. 05). Before surgery,there was no statistically significant difference in levels of serum MDA,SOD,TNF-α,CRP,HMGB1 and IL-6 between the pretreatment group and the routine group(P > 0. 05). 24 h after the operation,the levels of serum MDA,TNF-α,CRP,HMGB1,IL-6 were(4. 36 ± 1. 33) μmol/L,(5. 20 ± 1. 64) μg/L,(34. 75 ± 6. 83) mg/L,(258. 4 ± 41. 7)μg/L,(31. 28 ± 9. 50) μg/L,which were lower than the conventional group[(5. 11 ± 1. 57) μmol/L,(7. 00 ± 2. 17) μg/L,(43. 80 ± 8. 53)mg/L,(295. 0 ± 46. 4) μg/L,(48. 64 ± 11. 57) μg/L](P < 0. 05),the level of serum SOD [(126. 9 ± 25. 0) U/L] of the pretreatment group was higher than that of the routine group [(113. 1 ± 19. 6) U/L],the differences were statistically significant(P < 0. 05). The surgical complication rate of the pretreatment group(12. 50%) compared with the routine group(21. 28%),the difference was not statistically significant(P > 0. 05). Conclusion Dex pretreatment can significantly reduce liver ischemia-reperfusion injury and protect liver function.