关键词: 原发性肝癌, 肝叶切除术, 右美托咪定, 肝缺血再灌注损伤, 氧化应激, 细胞因子, 诱导麻醉

Abstract: Objective The aim of this study was to observe effects of dexmedetomidine (DEX) for anesthesia induction on hepatic ischemia-reperfusion injury (HIRI) in patients with primary liver cancer (PLC) undergoing hepatectomy. Methods A total of 81 patients with PLC were encountered in our hospital between June 2021 and January 2023, and were randomly divided into control (n=41) and observation (n=40) groups. All patients in the two groups underwent hepatectomy, and for anesthesia induction, all patients received intravenous fentanyl, cisatracurium and propofol, and patients in the observation received additional DEX administration, then, all patients received intravenous drip of DEX, remifentanil and propofol for anesthesia untill the end of surgery. Serum malondialdehyde (MDA), superoxide dismutase (SOD), glutathione (GSH), tumor necrosis factor-α (TNF-α), interleukin (IL)-6 and IL-8 levels were detected by ELISA. Results At inflow occlusion, one hour, six hours and twenty-four hours after anesthesia, serum ALT levels in the control group were(98.1±10.8)U/L, (168.5±13.2)U/L, (196.7±14.9)U/L and (179.1±13.7)U/L, all significantly higher than [(86.6±10.1)U/L, (124.3±11.3) U/L, (143.8±12.4) U/L and (121.3±11.5)U/L, respectively, P<0.05], serum AST levels were (118.4±11.7)U/L, (186.3±14.0)U/L, (226.3±16.5)U/L and (192.3±15.4)U/L, all significantly higher than [(92.3±12.1) U/L, (133.6±13.4) U/L, (161.8±15.3)U/L and (136.8±14.0) U/L, respectively, P<0.05] in the observation group, and six hours and twenty-four hours after anesthesia, serum bilirubin levels in the control group were (26.4±5.1)μmol/L and (31.5±4.8)μmol/L, both significantly higher than [(18.2±4.8)μmol/L and (22.4±5.0)μmol/L, respectively, P<0.05] in the observation group; one hour, six hours and twenty-four hours after anesthesia, serum MDA level in the observation group was much lower than in the control (P<0.05), while serum SOD and GSH levels were much higher than in the control group (P<0.05); serum TNF-α, IL-6 and IL-8 levels in the observation group were much lower than in the control group (P<0.05). Conclusion DEX administration for anesthesia induction with combination of others in patients with PLC undergoing hepatectomy could alleviate HIRI, which might be related to inhibition of perioperative oxidative stress and cytokine release, and needs further clinical investigation.

Key words: Hepatoma, Hepatectomy, Hepatic ischemia-reperfusion injury, Dexmedetomidine, Anesthesia induction, Oxidative stress, Cytokines