摘要
目的评价七氟烷麻醉下行肝癌切除术患者术中实施肝门阻断的缺血后处理的临床效应。方法择期行肝癌切除术男性患者40例,年龄45～65岁,体重指数20～26kg/m2,ASAⅡ,随机分为对照组(A组)与缺血后处理组(B组),每组20例。常规监测心电图、心率和平均动脉压。术中吸入七氟烷2%～4%、瑞芬太尼4～6ng/ml维持BIS40～45。患者均用Pringel法阻断入肝血流。A组实施常规肝门阻断与开放。B组开放前先给予短暂开放1min、阻断1min、反复3次缺血后处理,之后再行完全开放。记录手术时间、肝门阻断的时间和术中晶体量、胶体量;在肝门阻断前、肝脏恢复血流灌注后1h各楔型切取肝组织1块检测Fas-mRNA表达;术前、术后第1、3、5天肝功能检测。结果 Fas-mRNA在B组的表达均低于A组(P<0.05)。与术前比较,2组患者术后肝功能均升高;B组术后第1、3天丙氨酸转氨酶、天门冬氨酸转氨酶优于A组(P<0.05),第5天较第1天降低(P<0.05),2组第5天差异无统计学意义(P>0.05)。结论缺血后处理对于肝癌手术患者术中缺血再灌注损伤具有一定的脏器保护作用。
Objective To investigate the effects of ischemic post- processing by blocking hepatic hilum in patients undergoing hepatectomy. Methods Forty male ASA II patients with liver cancer, aged 45 ~ 65 years and BMI 20 - 26kg/m2, who underwent hepatectomy, were randomly divided into two groups （ n = 20 in each group） ：control group （group A ） and ischemic post processing group （group B）. The perioperative routine monitoring included electrocardiogram （ECG）, heart rate, mean arterial blood pressure. During operation BIS was maintained at 40 ~45 by 2% -4% sevoflurane and remifentanil 4 ~ 6ng/ml. The occlusion of the hepatic hilum were produced with the Pringel method in all patients. The occlusion of hepatic hilum was performed by routine method in group A, however, in group B the hepatic hilum was occluded for lmin, followed by 1-minute reperfusion,repeating 3 times. The duration of operation and occlusion of hepatic hilum, colloidal volume and crystal volume were recorded. The patients＇ venous blood samples were taken for the detection of liver function before operation and at 1,3 and 5 days after operation. The liver tissues were prepared for determination the expression of Fas-mRNA before occlusion and after 1-hour reperfusion. Results The expressions of Fas-mRNA in group B were significantly lower than those in group A （ P 〈 0.05 ）. As compared with that before operation, the liver function was improved in both groups after operation, and the AST and ALT activities in group B at 1,3 days after operation were significantly higher than those in group A （ P 〈 0. 05 ）, which at 5 day were significantly lower than those at 1 day （ P 〈 0. 05）, however, there was no significant difference in the levels of ALT and AST at 5 days after operation between two groups （ P 〉 0. 05 ）. Conclusion The ischemic post processing has certain protective effect on the ischemic- reperfusion injury of liver in patients with hepatic cancer during hepatectomy.
出处
《河北医药》
CAS
2011年第21期3208-3210,共3页
Hebei Medical Journal
基金
河北省普通高等学校强势特色学科肿瘤学建设经费资助项目(编号:200552)
河北省医学科学研究重点课题(编号:08159)
