摘要
目的探讨右美托咪定经门静脉预处理对肝部分切除术患者术中肝脏缺血-再灌注损伤中炎症反应和氧化应激的影响。方法拟在全麻下行肝部分切除术患者60例,男34例,女26例,年龄25~64岁,体重55~70 kg,ASAⅡ级,肝功能Child-Pugh A级。采用随机数字表法将患者分为三组,每组20例。DP组在游离出门静脉后经门静脉输注右美托咪定1.0μg/kg,DJ组在游离出门静脉后经颈内静脉输注右美托咪定1.0μg/kg,C组给予等容量生理盐水。分别于肝门阻断前10 min、肝门开放后1、6、12、24 h经颈内静脉采血检测血清ALT、AST、TNF-α、IL-33、高迁移率族蛋白1(HMGB1)、血红素氧合酶-1(HO-1)浓度和超氧化物歧化酶(SOD)活性。结果与肝门阻断前10 min比较,肝门开放后1、6、12、24 h三组血清ALT、AST、TNF-α、IL-33、HMGB1和HO-1浓度明显升高,SOD活性明显降低(P<0.05)。与C组比较,肝门开放后1、6、12、24 h DP组和DJ组血清ALT、AST、TNF-α、IL-33、HMGB1浓度明显降低,HO-1浓度和SOD活性明显升高(P<0.05)。与DJ组比较,肝门开放后1、6、12、24 h DP组血清ALT、AST、TNF-α、IL-33、HMGB1浓度明显降低,HO-1浓度和SOD活性明显升高(P<0.05)。结论经门静脉输注右美托咪定能更有效抑制炎症反应和氧化应激,增强机体抗炎抗氧化能力,减轻肝部分切除术患者肝缺血-再灌注损伤。
Objective To investigate the effects of dexmedetomidine via portal vein preconditioning on inflammatory response and oxidative stress in hepatic ischemia-reperfusion injury. Methods Sixty patients with partial hepatectomy under general anesthesia, 34 males and 26 females, aged 25-64 years, weighing 55-70 kg, ASA physical status Ⅱ, and liver function Child-Pugh grade A, were divided into three groups(n = 20 each) by using a random number table method: dexmedetomidine via the portal vein infusion group(group DP), dexmedetomidine via the internal infusion group(group DJ) and control group(group C). In group DP, dexmedetomidine 1.0 μg/kg was infused via the portal vein after the portal vein was released. In group DJ, dexmedetomidine was 1.0 μg/kg via the internal jugular vein after the portal vein was released. Group C was given an equal volume of normal saline. Serum ALT, AST, TNF-α, IL-33, high mobility group protein 1(HMGB1), heme oxygenase-1(HO-1) and superoxide dismutase(SOD) activity were detected at internal jugular vein 10 min before hepatic portal occlusion and 1, 6, 12 and 24 hours after hepatic portal opening. Results Compared with 10 min before hepatic portal occlusion, the serum concentrations of ALT, AST, TNF-α, IL-33, HMGB1 and HO-1 were significantly increased and the activity of SOD was significantly decreased in the three groups at 1, 6, 12 and 24 hours after hepatic portal occlusion(P < 0.05). Compared with group C, the serum concentrations of ALT, AST, TNF-α, IL-33 and HMGB1 were decreased significantly, while HO-1 concentration and SOD activity were increased significantly in group DP and group DJ at 1, 6, 12 and 24 hours after porta hepatis opening(P < 0.05). Compared with group DJ, the concentration of ALT, AST, TNF-α, IL-33 and HMGB1 were decreased significantly, while the concentration of HO-1 and the activity of SOD were increased significantly in group DP at 1, 6, 12 and 24 hours after porta hepatis opening(P < 0.05). Conclusion Portal intravenous infusion of dexmetomidine can more
作者
邢现良
朱妍梦
汤斌铨
邓欢玲
邓福谋
胡衍辉
XING Xianliang;ZHU Yanmeng;TANG Binquan;DENG Huanling;DENG Fumou;HU Yanhui(Department of Anesthesiology,the Second Affiliated Hospital of Nanchang University,Nanchang 330006,China)
出处
《临床麻醉学杂志》
CAS
CSCD
北大核心
2020年第4期317-321,共5页
Journal of Clinical Anesthesiology
关键词
右美托咪定
门静脉
肝脏缺血-再灌注损伤
氧化应激
炎症反应
Dexmedetomidine
Portal vein
Hepatic ischemia-reperfusion injury
Oxidative stress
Inflammatory response
