摘要
目的探讨异丙酚对肝叶切除术患者肝缺血再灌注损伤的影响。方法拟行肝叶切除术的肝癌患者60例，年龄28～64岁，体重50-77kg，ASAⅠ～Ⅲ级，随机分为对照组（Ⅰ组）和异丙酚组（Ⅱ组），每组30例。Ⅱ组肝门开放后静脉输注异丙酚4～6mg·kg^-1·h^-1至术毕。分别于麻醉前（T1）、肝门阻断前（T2）、肝门阻断后15min（T3）、肝门开放后10min（T4）和45min（T5）时抽取中心静脉血测定血清谷草转氨酶（AST）、谷丙转氨酶（ALT）、超氧化物歧化酶（SOD）活性，丙二醛（MDA）浓度。结果与T1时比较，两组T3-5，时AST、ALT活性升高，Ⅰ组T4-5时SOD活性降低、MDA浓度升高，Ⅱ组T4-5时SOD活性升高、MDA浓度降低（P〈0．05）；与Ⅰ组比较，Ⅱ组T4-5时AST、ALT活性降低，SOD活性升高、MDA浓度降低（P〈0．05）。结论肝门开放后至术毕静脉输注异丙酚4．6mg·kg^-1·h^-1可减轻肝叶切除术患者肝缺血再灌注损伤。
Objective To investigate the effect of propofol on hepatic ischemia-reperfusion injury. Methods Sixty ASA Ⅰ -Ⅲ patients with liver cancer aged 28-64 yr weighing 50-77 kg undergoing elective liver lobectomy were enrolled in this study. Patients with abnormal preoperative liver function and icterus or associated with cardiovascular disease or whose intraoperative blood loss 〉 1 500 ml were excluded from the study. The patients were randomly divided into 2 groups （ n = 30 each） ： group Ⅰ control and group Ⅱ propofol. The patients were premedicated with intramuscular Phenobarbital 0.1 g and atropine 0. 5 mg. Anesthesia was induced with midazolam, fentanyl, etomidale and vecuronium and maintained with inhalation of 40% N2O-60% O2 and 1%- 2 % isoflurane and intermittent iv boluses of vecuronium. In group Ⅱ propofol was continuously infused iv at 4-6 mg· kg^-1·h^-1 starting from dissection of hepatic portal until the end of surgery. Blood samples were taken from CVP line before induction of anesthesia （T1 ）, before （T2） and 15 min after （T3 ） occlusion of hepatic portal, 10 （T4 ） and 45 min （T5 ） after hepatic portal occlusion was released for determination of serum AST, ALT and SOD activities and MDA concentration. Results Serum AST and ALT activities were significantly increased at T3-5 as compared with the baseline values at T1 in both groups. The serum SOD activity was significantly decreased and MDA concentration was significantly increased at T4,5 as compared with the baseline at T1 in group Ⅰ ; while SOD activity was significantly increased and MDA concentration was significantly decreased at T4,5 as compared with the baseline at T1 in group Ⅱ . Serum AST and ALT activities and MDA concentration were significantly lower and SOD activity was significantly higher at T4,5 in group Ⅱ than in group Ⅰ. Conclusion Propofol can protect the liver from ischemia-reperfusion injury.
出处
《中华麻醉学杂志》
CAS
CSCD
北大核心
2008年第9期817-819,共3页
Chinese Journal of Anesthesiology
