异丙酚对围术期缺血-再灌注损伤肝脏的保护作用

目的　探讨异丙酚对围术期肝脏缺血再灌注损伤 (HIRI)的防治作用及其机制。方法　选择 18例肝癌手术患者 ,观察肝门阻断前后及再灌注后血中超氧化物歧化酶 (SOD)活性、黄嘌呤氧化酶 (XO)活性、脂质过氧化物 (L PO)浓度和丙氨酸转氨酶 (AL T)值 ;对再灌注 2 5 min时的肝组织进行电镜下肝细胞形态学变化的观察 ,以评价异丙酚对上述指标的影响。结果　 HIRI期间 ,SOD活性显著下降 (P<0 .0 1) ,XO活性、L PO浓度及 AL T值明显升高 (P均 <0 .0 1) ;肝组织超微结构发生异常改变。使用异丙酚后 ,上述指标的异常变化显著减轻 ,其差异有显著意义 (P<0 .0 5或 P<0 .0 1)。结论　异丙酚可通过降低氧自由基水平、拮抗脂质过氧化反应 ,对围术期 HIRI起积极的防治作用。

Protective effect of propofol on liver during ischemia-reperfusion injury in patients undergoing liver surgery

Objective To explore the protective effect of propofol on liver during hepatic ischemia/reperfusion injury ( HIRI ) and its mechanisms in patients undergoing liver surgery. Methods Eighteen patients who were scheduled for selective hepatic surgery were randomly divided into control group(n=9) and propofol treatment group(n=9). Changes of several parameters in plasma and effects of propofol on them were observed before liver ischemia,at end of ischemia and at reperfusion for 25 minutes, parameters of which included superoxide dismutase (SOD), xanthine oxidase (XO), lipid peroxide (LPO) and alanine aminotrasferase (ALT) activity, and the ultrastructure changes in liver tissue were observed under electron microscope at 25 minutes after reperfusion. Results SOD activity decreased remarkably (P<0.01); XO activity, LPO concentration and ALT value increased significantlly (P<0.01) during HIRI,and there were abnormal changes of the hepatic ultrastructure at 25 minutes after reperfusion. Afer treatment with propofol, the variation of all parameters were alleviated markedly ( P<0.05 and P<0.01). Conclusion Propofol has protective effects on HIRI by reducing oxygen free radical level and inhibiting lipid peroxidation after hepatic ischemia/reperfusion in patients undergoing liver cancer surgery.