药物治疗在肝切除术中预防缺血再灌注损伤的研究进展

Progress of pharmacotherapy in the prevention of ischemia-reperfusion injury during hepatectomy

肝切除术中常采用肝门阻断和控制中心静脉压的方法减少出血,保证手术视野清晰,从而使手术顺利进行,但在肝门阻断和开放过程中会导致肝脏缺血再灌注损伤(hepatic ischemia-reperfusion injury,HIRI)、胃肠道淤血、肠源性细菌移位等问题。因此,围术期采取各种措施减轻因肝门阻断引起的HIRI进而提高手术的安全性成为肝切除术的研究热点。缺血预处理、亚低温处理、药物治疗、抗凋亡基因治疗等方法应运而生,其中药物治疗具有可操作性强、相对安全、临床上易操作等优势,因而受到广泛关注。本文对有助于改善HIRI的部分代表药物及作用机制进行总结,为HIRI的临床诊治提供参考。

Hepatic portal blockade and central venous pressure control were often used in hepatectomy to reduce bleeding and ensure a clear surgical field so that the operation can be carried out smoothly,but the process of hepatic portal blockade and opening can lead to hepatic ischemia-reperfusion injury(HIRI),gastrointestinal stagnation,and intestinal bacterial translocation.Therefore,perioperative measures to alleviate HIRI caused by hepatic portal blockade and to improve the safety of surgery have become a hot research topic in hepatic resection.Methods such as ischemic preconditioning,subcooling,drug therapy,and anti-apoptotic gene therapy have emerged,among which drug therapy has the characteristics of strong operability,relative safety,and easy access in clinic,and thus it has received extensive attention.This article summarizes the drugs and mechanisms that are representative of the improvements in HIRI,to provide reference for clinical diagnosis and treatment of HIRI.