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右美托咪定对肝叶切除患者肝功能、细胞因子及氧化应激的影响
Effect of dexmedetomidine on liver function, cytokine levels, and oxidative stress in patients undergoing hepatolobectomy
文章发布日期:2017年01月26日  来源:  作者:张 宁,郭振中,程 燕  点击次数:500次  下载次数:105次

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【摘要】:目的探讨右美托咪定对肝叶切除患者肝功能、血浆细胞因子水平及缺血再灌注损伤氧化应激的影响。方法选取2014年1月-2016年1月于冀中能源峰峰集团有限公司总医院行肝叶切除术的患者106例,随机分为对照组及观察组,每组各53例,观察组予以右美托咪定1 μg·kg-1·h-1,注射时间为10 min,随后以0.5 μg·kg-1·h-1持续输注;对照组患者予以等量09%氯化钠。比较2组患者麻醉后(T1)、关腹前(T2)、手术结束后1 h(T3)、手术结束后4 h(T4)、手术结束后8 h(T5)的肝功能指标、血浆细胞因子水平及缺血再灌注损伤氧化应激因子水平。计数资料组间比较采用χ2检验;计量资料2组间比较采用t检验,T1~T5不同时间点测量的各观察指标进行球形检验,符合P<0.05则进行重复测量资料的方差分析。结果2组患者T2、T3、T4、T5各时间点的ALT、AST水平明显高于T1时间点(ALT:F值分别为43.72、44.16,P值均<0.001;AST:F值分别为53.87、65.44,P值均<0001),且观察组低于对照组(ALT:t值分别为20.54、22.01、36.68、38.15,P值均<0.001;AST:t值分别为32.27、41.08、52.82、71.89,P值均<0.001);2组患者T3、T4、T5各时间点的TNFα、IL-8水平明显高于T1时间点(TNFα:F值分别为5437、2475,P值均<0.001;IL-8:F值分别为47.24、27.39,P值均<0.001),且观察组低于对照组(TNFα:t值分别为59.39、8632、8316,P值均<0.001;IL-8:t值分别为74.47、72.29、76.67,P值均<0.001)。2组患者T3、T4、T5各时间点的MDA水平均明显高于T1时间点(F值分别为37.65、17.44,P值均<0.001),且观察组低于对照组(t值分别为17.35、19.11、24.12,P值均<0001);2组患者T3、T4、T5各时间点的超氧化物歧化酶水平均明显低于T1时间点(F值分别为36.54、33.65,P值均<0.001),且观察组高于对照组,差异有统计学意义(t值分别为68.64、66.35、59.48,P值均<0.001)。结论在肝叶切除术中应用右美托咪定,能够有效抑制肝损伤及细胞因子的释放,减轻缺血再灌注损伤。
【Abstract】:ObjectiveTo investigate the effect of dexmedetomidine on liver function, plasma cytokine levels, and oxidative stress due to ischemia/reperfusion injury in patients undergoing hepatolobectomy. MethodsA total of 106 patients who underwent hepatolobectomy in General Hospital of Jizhong Energy Fengfeng Group Co., Ltd. from January 2014 to January 2016 were enrolled and randomly divided into control group and observation group, with 53 patients in each group. The patients in the observation group were given 1 μg/kg/h dexmedetomidine within 10 minutes, followed by continuous intravenous infusion of 0.5 μg/kg/h dexmedetomidine, and those in the control group were given an equal volume of 0.9% sodium chloride. The two groups were compared in terms of liver function parameters, plasma cytokine levels, and oxidative stress due to ischemia/reperfusion injury after anesthesia (T1), before abdominal closure (T2), and at 1, 4, and 8 hours after surgery (T3, T4, and T5, respectively). The chi-square test was used for comparison of categorical data between groups; the t-test was used for comparison of indices between groups, the sphericity test was used for comparison of indices at different time points, and an analysis of variance was performed for repeated measurement data with P<0.05. ResultsThe two groups had significantly higher alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels at T2, T3, T4, and T5 than at T1 (ALT: F=43.72 and 44.16, both P<0.001; AST: F=53.87 and 65.44, both P<0.001), and the observation group had significantly lower levels than the control group at T2, T3, T4, and T5 (ALT: t=20.54, 22.01, 36.68, and 38.15, all P<0.001; AST: t=32.27, 4108, 52.82, and 71.89, all P<0.001). The two groups had significantly higher levels of tumor necrosis factor α (TNFα) and interleukin-8 (IL-8) at T3, T4, and T5 than at T1 (TNFα: F=54.37 and 24.75, both P<0.001; IL-8: F=47.24 and 27.39, both P<0.001), and the observation group had significantly lower levels than the control group at T3, T4, and T5 (TNFα: t=59.39, 86.32, and 83.16, all P<0.001; IL-8: t=74.47, 72.29, and 76.67, all P<0.001). The two groups had a significantly higher level of malondialdehyde at T3, T4, and T5 than at T1 (F=37.65 and 17.44, both P<0.001), and the observation group had a significantly lower level than the control group at T3, T4, and T5 (t=17.35, 19.11, and 24.12, all P<0.001). The two groups had a significantly lower level of superoxide dismutase at T3, T4, and T5 than at T1 (F=36.54 and 33.65, both P<0.001), and the observation group had a significantly higher level than the control group at T3, T4, and T5 (t=68.64, 66.35, and 59.48, all P<0.001). ConclusionDexmedetomidine can effectively inhibit liver injury, reduce the levels of cytokines, and alleviate ischemia/reperfusion injury in patients undergoing hepatectomy.
【关键字】:肝切除术;再灌注损伤;细胞因子类;肾上腺素能α激动剂
【Key words】:hepatectomy; reperfusion injury; cytokines; adrenergic alpha-agonists
【引证本文】:张宁,郭振中,程燕. 右美托咪定对肝叶切除患者肝功能、细胞因子及氧化应激的影响[J]. 临床肝胆病杂志, 2017, 33(3): 507-511.

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