术前扩容对预防妇科腹腔镜致缺血再灌注肝损害的研究

目的 探讨腹腔镜术前扩容与预防经妇科腹腔镜手术所致肝功能损害的相关性.方法 将我院80例妇科腹腔镜手术患者随机分为术前扩容治疗组(Ⅰ组)和非术前扩容治疗组(Ⅱ组),每组40例；检测并对比各组患者术后肝脏缺血再灌注各个时点(T=1h、3h、6h、12h)肝功能(丙谷氨酸转氨酶ALT、天门冬氨酸转氨酶AST)及缺血再灌注损伤标记物脂质过氧化物丙二醛(MDA)在缺血再灌注期内的水平变化情况.结果 Ⅱ组肝脏缺血再灌注各个时点( T=1 h、3h、6h、12h)的肝功能血清ALT、AST水平及缺血再灌注损伤标记物MDA均明显高于Ⅰ组(P＜0.05)；各组血清ALT、AST及MDA水平在缺血再灌注期均呈增高趋势,且在再灌注6h时达高峰,但在12h时有显著回落趋势(P＜0.05)；与Ⅱ组相比,Ⅰ组在缺血再灌注期内的ALT、AST及MDA水平等实验室检查指标波动相对平稳,两组结果差异具有统计学意义(P＜0.05).结论 术前扩容可有效保护腹腔镜手术患者术后肝脏缺血再灌注期的肝功能,是行之有效的预防妇科腹腔镜手术肝功能损伤的治疗措施.

Preoperative volume expansion in prevention of ischemia-reperfusion liver injury induced by gynecological laparoscopy

Objective To explore the correlation of preoperative volume expansion with liver injury induced by gynecologic laparoscopic surgery. Methods 80 patients undergoing gynecologic laparoscopic surgery in our hospital were randomly divided into group of preoperative volume expansion （ group I ） and group of non- preoperative expansion （ group II ）, 40 for each group. Changes in postoperative liver function （ ALT and AST ）and ischemia-reperfusion injury marker malondialdehyde （ MDA ） during the ischemia-reperfusion period were detected at different time points （ hours 1, 3, 6, and 12 ）. Results Levels of ALT, AST, and MDA were markedly higher in group II than in group I at all of the different time points （ P 〈 0.05 ）. Serum levels of ALT, AST and MDA in the ischemic-reperfusion period showed a increasing trend, reached their peak values at hour 6, but declined significantly at hour 12 （ P〈 0.05 ）. As compared with group II, levels of ALT, AST, and MDA were relatively stable in group I, with a significance difference （ P〈 0.05 ）. Conclusions Preoperative volume expansion can effectively protect liver function from ischemia-reperfusion injury induced by laparoscopic surgery in patients.