门静脉注射异丙酚对家兔肝脏缺血再灌注损伤的保护作用
周党军 吕毅 安东均 罗遥 张成
摘 要
目的：探讨麻醉药物异丙酚经门静脉给药对肝脏缺血再灌注（I/R）损伤的保护作用及其可能机制。
方法：将动物随机分为4组，每组8只。A组为假手术组，仅开关腹；B组为单纯阻断入肝血流30min再灌注60min（I/R）组；C组为I/R组+颈静脉注射异丙酚组；D组为I/R组+门静脉注射异丙酚组；。检测各组家兔血清ALT和AST、肝组织及血液中内皮素-1（ET-1）和一氧化氮（NO）以及肝组织中ATP含量。
结果：门静脉注射异丙酚可降低I/R期间血清ALT、AST及肝组织和血液中ET-1，提高肝组织和血液中NO及肝组织中ATP含量，其对肝I/R损伤的保护效应优于颈静脉给药。
结论：经门静脉注射异丙酚对肝脏I/R损伤有明显的保护作用，此作用可能是通过调节ET-1与NO浓度的失衡及提高肝组织中ATP含量而实现的。
ABSTRACT
Objective:To investigate the protective effect of propofol on hepatic ischemia reperfusion（I/R）injury and its possible mechanism.
Methods:The animals were randomly divided into four groups，8 in each group.Group A was a sham operation group，only switching abdomen.Group B was treated by blocking the hepatic blood flow for 30 minutes and reperfusion for 60 minutes（I/R）.Group C was divided into I/R group and jugular vein injection propofol group.Group D was divided into I/R group and propofol group by portal vein injection.The levels of ALT and AST in serum，endothelin-1（ET-1）and nitric oxide（NO）in liver tissue and blood，and ATP in liver tissue were measured.Its protective effect on hepatic I/R injury is better than that of jugular vein administration.
Results:Intravenous propofol can reduce serum ALT，AST and ET-1 in liver tissue and blood during I/R.Increase the content of NO in liver tissue and blood and ATP in liver tissue.Its protective effect on hepatic I/R injury is better than that of jugular vein administration.
Conclusion:Intravenous injection of propofol via portal vein has obvious protective effect on hepatic I/R injury.This effect may be achieved by regulating the imbalance between ET-1 and NO concentration and increasing ATP content in liver tissue.
关键词
肝/血液供给；缺血再灌注损伤；异丙酚；内皮素-1；一氧化氮；三磷酸腺苷
KEY WORDS
Liver/blood supply；Ischemia ReperfusionInjury；Propofol；Endothelin-1；NitricOxide；Adenosine Triphosphate
有关肝脏缺血再灌注损伤（hepaticischemia-reperfusioninjury，HIRI）机制和减轻肝脏缺血再灌注（I/R）损伤的研究已成为肝脏外科及肝脏移植基础研究的重要课题。研究证实麻醉药物异丙酚（propofol）能抑制离体鼠肝线粒体及微粒体的脂质过氧化反应［1-2］，对离体肝细胞有保护作用［3-4］。但其对在体肝脏的确切作用及机制尚不甚明了。由于肝脏外科手术很容易建立药物直接进入肝脏的通路，笔者设想通过门静脉途径给予麻醉药异丙酚，观察该途径对肝脏I/R损伤是否起到更好的保护作用。