Study of the protective effects of hypertonic saline against ischemia-reperfusion injury of the liver / 中国现代普通外科进展

ABSTRACT

Objective: To investigate the protective effects and the mechanism of the preconditioning with hypertonic saline against warm hepatic ischemia-reperfusion (I-R) injury. Methods: Sixty patients who underwent partial liver resection were randomly assigned to 3 groups (n =20) group 1 without Pringle maneuver(NPR); group 2 with Pringle maneuver (PR), and group 3 with 7.5% hypertonic saline 4ml/kg preconditioning (HS) 5 minutes before Pringle maneuver for resection and in group 2 , 4ml/kg normal saline were given. Blood samples were obtained at 3, 15, and 30 minutes before and after liver resection, and 2, 24, and 48 hours following resection of the liver for polymorphonuclear leukocytes (PMN) count and serum alanine transminase levels test. In addition, small pieces of liver tissue were cut from remaining liver before resection and 30 minutes after resection to determine MPO concentrations. Results: Following partial liver resection via NPR, no changes in the concentration of circulating PMN and liver MPO concentrations were observed. But in the PR and HS group PMN counts significantly decreased and liver MPO concentrations significantly increased. Serum ALT levels increased in all groups significantly 24 and 48 hours after resection. All of these changes were most pronounced in the PR group and significantly reduced by hypertonic saline. Conclusion: Preconditioning with 7.5% hypertonic saline can protect liver from warm ischemia reperfusion injury and the possible mechanism was the inhibition of PMN accumulation in the liver.