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目的探讨丙泊酚-瑞芬太尼对肝脏缺血再灌注损伤的保护作用以及作用机制。方法 2009年6月-2011年12月选择择期需阻断肝门的肝脏手术患者40例,随机分为丙泊酚-瑞芬太尼组(P组)和异氟醚组(I组),每组20例。在术前(T0)和肝门阻断开放后30 min(T1)、60 min(T2)、6 h(T3)、24 h(T4)、72 h(T5)分别抽取动脉血,测定天冬氨酸氨基转移酶(AST)、丙氨酸氨基转移酶(ALT)和肿瘤坏死因子α(TNF-α)的含量。结果两组AST、ALT、TNF-α较术前均有增高,差异有统计学意义(P<0.05);P组增高幅度明显低于I组,差异有统计学意义(P<0.05)。结论丙泊酚-瑞芬太尼对肝脏缺血再灌注损伤具有保护作用,抑制TNF-α的产生可能为其作用机制之一。
Objective To investigate the protective effect of propofol-remifentanil on hepatic ischemia-reperfusion injury and its mechanism. Methods From June 2009 to December 2011, 40 patients undergoing elective hepatic resection of hepatic hilar were randomly divided into propofol-remifentanil group (P group) and isoflurane group (I group) 20 cases in each group. Arterial blood was collected at preoperative (T0) and 30 min (T1), 60 min (T2), 6 h (T3), 24 h (T4) and 72 h (T5) (AST), alanine aminotransferase (ALT), and tumor necrosis factor alpha (TNF-alpha) were measured. Results The levels of AST, ALT and TNF-α in both groups were significantly higher than those before operation (P <0.05). The increase in group P was significantly lower than that in group I (P <0.05). Conclusion Propofol-remifentanil has a protective effect on hepatic ischemia-reperfusion injury and inhibition of TNF-α production may be one of its mechanisms.