CAJ | 학술논문

目的评价甲强龙对肝叶切除术病人肝缺血再灌注损伤的影响.方法择期行肝叶切除术的肝癌病人60例,性别不限,年龄30 ～ 64岁,体重45 ～ 75 kg,ASA分级Ⅱ或Ⅲ级,术中均需阻断肝门行肝部分切除.采用随机数字表法,将其分为2组(n=30):对照组(C组)和甲强龙组(M组).M组于麻醉诱导后切皮前静脉输注甲强龙500 mg(溶于加入100ml生理盐水中),输注速率5 ml/min.静脉注射异丙酚、芬太尼和顺式阿曲库铵诱导麻醉,气管内插管后行机械通气,维持PETCO2 35 ～ 45mmHg.吸入1％～3％七氟醚,静脉输注瑞芬太尼,间断静脉注射芬太尼和顺式阿曲库铵维持麻醉.术中维持MAP 70～ 100 mmHg,HR 50-90次/min.分别于麻醉诱导前10 min、术后1、3和5d时抽取静脉血样,测定血浆ALT、AST和总胆红素的水平,采用放免法检测血浆TNF-α和IL-6的浓度.结果与C组比较,M组术后1和3d时血浆AST、ALT和总胆红素的水平降低,术后1、3和5d时血浆TNF-α和IL-6的浓度降低(P＜0.05).结论甲强龙可减轻肝叶切除术病人肝缺血再灌注损伤,其机制与抑制全身炎性反应有关.
목적 평개갑강룡대간협절제술병인간결혈재관주손상적영향.방법 택기행간협절제술적간암병인60례,성별불한,년령30 ～ 64세,체중45 ～ 75 kg,ASA분급Ⅱ혹Ⅲ급,술중균수조단간문행간부분절제.채용수궤수자표법,장기분위2조(n=30):대조조(C조)화갑강룡조(M조).M조우마취유도후절피전정맥수주갑강룡500 mg(용우가입100ml생리염수중),수주속솔5 ml/min.정맥주사이병분、분태니화순식아곡고안유도마취,기관내삽관후행궤계통기,유지PETCO2 35 ～ 45mmHg.흡입1％～3％칠불미,정맥수주서분태니,간단정맥주사분태니화순식아곡고안유지마취.술중유지MAP 70～ 100 mmHg,HR 50-90차/min.분별우마취유도전10 min、술후1、3화5d시추취정맥혈양,측정혈장ALT、AST화총담홍소적수평,채용방면법검측혈장TNF-α화IL-6적농도.결과 여C조비교,M조술후1화3d시혈장AST、ALT화총담홍소적수평강저,술후1、3화5d시혈장TNF-α화IL-6적농도강저(P＜0.05).결론 갑강룡가감경간협절제술병인간결혈재관주손상,기궤제여억제전신염성반응유관.
Objective To evaluate the effect of methylprednisolone on hepatic ischemia-reperfusion (I/R) injury in the patients undergoing hepatolobectomy.Methods Sixty ASA physical status Ⅱ or Ⅲ patients,aged 30-64 yr,weighing 45-75 kg,scheduled for elective hepatolobectomy,were randomized to control group or methylprednisolone group (n =30 each).After induction of anesthesia,methylprednisolone 500 mg (in 100 ml of normal saline) was infused intravenously at 5 ml/min before skin incision in group M.Anesthesia was induced with propofol,fentanyl and cisatracurium.The patients were endotracheally intubated and mechanically ventilated.PETCO2 was maintained at 35-45 mmHg.Anesthesia was maintained with 1％-3％ sevoflurane inhalation,remifentanil infusion,and intermittent iv boluses of fentanyl and cisatracurium.MAP was maintained at 70-100 mmHg and HR at 50-90 bpm.At 10 min before induction of anesthesia,and on postoperative day 1,3 and 5,venous blood samples were collected for determination of the plasma levels of alanine aminotransferase (ALT),aspartate amminotransferase (AST),total bilirubin (TBIL),tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6).Results Compared with group C,the plasma levels of ALT,AST and TBIL were significantly decreased on postoperative day l and 3,and the plasma concentrations of TNF-α and IL-6 were decreased on postoperative day 1,3 and 5 in group M.Conclusion Methylprednisolone can reduce hepatic I/R injury in the patients undergoing hepatolobectomy and inhibition of systemic inflammatory responses is involved in the mechanism.