丙泊酚-瑞芬太尼对肝脏缺血再灌注损伤的影响

目的探讨丙泊酚-瑞芬太尼对肝脏缺血再灌注损伤的保护作用以及作用机制。方法 2009年6月-2011年12月选择择期需阻断肝门的肝脏手术患者40例,随机分为丙泊酚-瑞芬太尼组(P组)和异氟醚组(I组),每组20例。在术前(T0)和肝门阻断开放后30 min(T1)、60 min(T2)、6 h(T3)、24 h(T4)、72 h(T5)分别抽取动脉血,测定天冬氨酸氨基转移酶(AST)、丙氨酸氨基转移酶(ALT)和肿瘤坏死因子α(TNF-α)的含量。结果两组AST、ALT、TNF-α较术前均有增高,差异有统计学意义(P<0.05);P组增高幅度明显低于I组,差异有统计学意义(P<0.05)。结论丙泊酚-瑞芬太尼对肝脏缺血再灌注损伤具有保护作用,抑制TNF-α的产生可能为其作用机制之一。

Influence of Propofol-remifentanil on Hepatic Ischemia-Reperfusion Injury

Objective To study the protection effect of propofol-remifentanil on hepatic ischemia-reperfusion injury and its possible mechanisms.Methods Forty patients needed to undergo the surgery of blocking liver porta between June 2009 and December 2011.They were randomly divided into the propofol-remifentanil group(P group) and isoflurane group(I group),with 20 patients in each.Arterial blood was collected and its aspartate aminotransferase(AST),alanine aminotransferase(ALT) and TNF-α levels were measured before surgery(T0),and 30 minutes(T1),60 minutes(T2) and 6 hours(T3),one day(T4),and 3 days(T5) after portal triad clamping and opening.Results AST,ALT and TNF-α levels raised in both groups after operation(P < 0.05).The changing level for patients in the P group was significantly higher than that for patients in the I group(P < 0.05).Conclusion Propofol-remifentanil can protect the liver with hepatic ischemiareperfusion injury,and the inhibition of TNF-α production may be one of the mechanisms.