参附注射液预处理联合控制性低中心静脉压对肝脏缺血-再灌注损伤的影响

摘要

目的：探讨参附注射液预处理联合控制性低中心静脉压用于肝脏部分切除术中对肝脏缺血-再灌注损伤的影响及可能的作用机制。方法择期行肝脏部分切除手术患者80例,ASA Ⅰ或Ⅱ级,随机分为四组：参附预处理联合控制性低中心静脉压组(SL 组)、参附预处理组(S 组)、控制性低中心静脉压组(L 组)和对照组(C 组)。分别于肝门阻断前10 min(T1)、肝门开放后5 min(T2)、术后6 h(T3)、24 h(T4)经颈内静脉抽血进行血清超氧化物歧化酶(SOD)和 IL-10的测定,并检测血清 ALT、AST 浓度,记录 MAP、HR 和 CVP。结果与 C 组和 S 组比较,T1、T2时 L 组和 SL 组CVP 明显降低(P <0.01)。与 T1时比较,T2~T4时四组患者血清 SOD 浓度明显降低(P <0.05), ALT、AST、IL-10浓度明显升高(P <0.01)。与 C 组比较,T2~T4时 SL 组、S 组血清 SOD,SL 组、S组和 L 组 IL-10浓度明显升高(P <0.05或 P <0.01),ALT、AST 浓度明显降低(P <0.05)。与 SL组比较,T2~T4时 S 组和 L 组血清 IL-10浓度明显降低(P <0.01),ALT、AST 浓度明显升高(P <0.01)。结论参附注射液预处理联合控制性低中心静脉压技术用于肝脏部分切除术中,可以触发机体组织产生内源性抗损伤机制阻断导致缺血-再灌注损伤的多重因素从而达到肝脏保护作用。%Objective To investigate the protective effects of Shenfu injection pretreatment combined with controlled low central venous pressure (LCVP)on hepatic ischemia-reperfusion injury (HIRI)during liver resection and its possible mechanism.Methods Eighty patients,ASA Ⅰ or Ⅱ, scheduled for liver resection were randomly divided into four groups:Shenfu pretreatment combined with controlled low central venous pressure group (group SL),Shenfu pretreatment group (group S),controlled low central venous pressure group (group L),control group (group C),twenty pa-tients in each group.The venous blood samples were drawn from internal carotid vein at different time points:pre-occlusion ten minutes (T1 ),post-occlusion five minutes (T2 ),6 h (T3 ),24 h after oper-ation (T4 ),and then detected the levels of serum superoxide dismutase (SOD),IL-10,ALT and AST.MAP,HR,CVP were recorded.Results Compared with group C and group S,CVP were sig-nificantly lower at T1 ,T2 in group L and group SL(P < 0.01 ).Compared with T1 ,level of serum SOD was significantly decreased at T2-T4 ,meanwhile levels of ALT,AST,IL-10 were significantly increased (P <0.01).Compared with group C,levels of SOD in group S and group SL at T2-T4 were significantly increased (P <0.05 or P <0.01 ),meanwhile levels of serum ALT,AST were signifi-cantly decreased.Compared with group SL,levels of serum IL-10 in group S and group L at T2-T4 were both significantly decreased,while the levels of ALT,AST were increased (P < 0.01 ). Conclusion Shenfu injection pretreatment combined with controlled low central venous pressure in liver re-section may have a protective effect on hepatic ischemia-reperfusion injury.The protective mechanism is probably that they trigger the endogenous resistance against injury mechanism and block up multiple factors which lead to hepatic ischemia-reperfusion injury.