ABSTRACT
Objective To evaluate the effect of controlled hypotension at the beginning of reperfusion on ischemia-reperfusion (I/R) injury of the liver in patients undergoing hepatectomy.Methods Forty ASA Ⅱ or Ⅲ patients (aged 30-60 years and weighing 40-70 kg) undergoing elective partial hepatectomy for liver cancer were randomly divided into two groups (n =20 each):normal blood pressure group (control group,group C) and controlled hypotension group (group H).In group C,normal blood pressure was maintained during reperfusion,while in group H,controlled hypotension (the mean arterial blood pressure (MAP) was maintained at 60-70 mm Hg) was performed for 10 minutes since the beginning of reperfusion.Hepatic portal was occluded during operation.Venous blood samples were taken before hepatic ischemia (T0,baseline) and after 15 minutes of ischemia (T1) and after 25 minutes of reperfusion (T2) for determination of plasma levels of endothelin (ET),nitric oxide (NO),tumor necrosis factor-alpha (TNF-α) and interleukin-1 (IL-1).Results I/R of the liver led to significant increases in plasma levels of ET,TNF-α and IL-1 and a decrease in plasma level of NO at T1,2 as compared with the baseline values at T0 in both groups.Plasma levels of ET,TNF-α and IL-1 were significantly lower while plasma level of NO was significantly higher at T2 in group H than in group C.Conclusion Controlled hypotension for 10 minutes in the initial stage of reperfusion can attenuate I/R-induced injury to the liver in patients undergoing hepatectomy through balancing ET with NO and inhibiting inflammation responses.
ABSTRACT
Objective To evaluate the effect of controlled hypotension at the beginning of reperfusion on ischemia-reperfusion (I/R) injury of the liver in patients undergoing hepatectomy. Methods Forty ASA Ⅱ or Ⅲ patients aged 30-60 yr weighing 40-70 kg undergoing elective partial hepatectomy for liver cancer were randomly divided into 2 groups ( n = 20 each): group C normal BP and group H controlled hypotension. Hepatic portal was occluded during operation. In group C normal BP was maintained during reperfusion while in group H controlled hypotension (MAP was maintained at 60-70 mm Hg) was performed for 10 min since the beginning of reperfusion.Venous blood samples were taken before hepatic ischemia (T0 ,baseline) and at 15 min of ischemia (T1) and 25 min of reperfnsion (T2 ) for determination of plasma endothelin (ET), nitric oxide(NO), TNF-α and IL-1 concentrations. Results I/R of the liver led to significant increase in plasma ET, TNF-α and IL-1 concentrations and decrease in plasma NO concentration at T1,2 as compared with the baseline values at T0 in both groups. Plasma ET,TNF-α and IL- 1 concentrations were significantly lower while plasma NO concentration was significantly higher at T2 in group H than in group C. Conclusion Ten minutes controlled hypotension in the initial stage of reperfusion can attenuate I/R-induced injury to the liver in patients undergoing hepatectomy by balancing ET with NO and inhibiting inflammation response.
ABSTRACT
35%.The patients were premedicated with intramuscular phenobarbital 0.1g and atropine 0.5 mg. In group B and C 8-12 ml?kg-1 of blood was withdrawn from cubital vein in 10-15 min and equal volume of 6% hydroxyethyl was infused at the same speed simultaneously before anesthesia. In group C the blood shed during operation was collected and anticoagulated for reinfusion. Anesthesia was induced with fentanyl 4-6?g?kg-1 , propofol 2 mg?kg-1 and pipecuronium 0.1 mg?kg-1.The patients were mechanically ventilated after tracheal intubation and PETCO2 was maintained at 25-35 mm Hg. Anesthesia was maintained with 1%-3% isoflurane and intermittent iv boluses of fentanyl and pipecuronium. Lactated Ringer's solution was infused at 10-12 ml?kg-1.h-1 during operation in all patients. ECG, NIBP, SpO2, PETCO2 and CVP were monitored throughout anesthesia. Plasma protein, Hct and Hb were measured before and after ANH and after reinfusion of the shed blood. Neuromuscular function was assessed using a train-of-four stimulation (TOF). Onset time, peak effect time (when T1 decreased to 0), duration of action (from the end of pipecuronium injection to recovery of T1 to 25% of the control) of intubation dose and maintenance dose and recovery index (recovery of T1 from 25 % - 75%) were recorded.Results Demographic data including sex, age, body weight and height were not significantly different among the three groups. The vital signs were stable in the three groups. Plasma total protein and albumin concentrations, Hb and Hct decreased significantly after ANH in group B and C and were significantly lower than those in group A. After autologous transfusion there was no significant difference in plasma protein concentration and Hb between group A and B. Hb and Hct were significantly higher in group C than those in group A and B (P