N-乙酰半胱氨酸对肝缺血再灌注损伤的抗氧化作用.docVIP

N-乙酰半胱氨酸对肝缺血再灌注损伤的抗氧化作用 蔡俊赢，徐国海，胡衍辉 （南昌大学第二附属医院麻醉科，江西 南昌 330006） 摘要: 目的　探讨N-乙酰半胱氨酸(NAC)对肝脏缺血再灌注损伤的抗氧化作用。方法　选择需肝门阻断肝脏手术病人40例,随机分为实验组和对照组，每组各20例。A组:术中静脉泵入NAC150mg/kg;B组:术中静脉泵入等量生理盐水。分别于肝门阻断前、阻断后30min,开放后1、6、24h抽血检测病人血浆的丙二醛(MDA)、超氧化物歧化酶(SOD)含量的变化。结果　手术时间，组间出血量，肝门阻断时间 差异无统计学意义。2组患者在T0后MDA浓度呈升高趋势,以T3时点为高峰,而SOD活性与T0相比呈逐渐下降趋势,T3时点值为谷低。A组MDA上升趋势低于B组,SOD下降趋势亦低于B组。结论　术中静脉泵入NAC150mg/kg对缺血再灌注损伤肝脏具有一定抗氧化作用。 关键词：N-乙酰半胱氨酸; 缺血再灌注损伤;肝脏;丙二醛 ABSTRACT Objective：To investigate the antioxidation of N-acetylcysteine (NAC) against ischemia-reperfusion injury and the possible mechanism.Methods：fourty patients needed to block porta hepatis undergoing liver operation, were randomly allocated into two groups (n=20 each): (2)150mg/kg NAC were given IV during operation(Group A) ; (1)normal saline were given(Group B). The levels of MDA、SOD were measured before porta hepatic blocking(T0), thirty minters after porta hepatic blocking(T1), 1 hour(T2), 6 hours(T3), 24 hours(T4)after porta hepatic opening. Results：The operation time, the amount of bleeding and the time of hepatic portal interruption have no significant difference in two groups. Compared with T0, the levels of MDA in other time points were significantly increased in two groups,the levels of SOD in other time points were significantly decreased in two groups. The levels of MDA were significantly higher in group B than in group A at T3. The levels of SOD were significantly lower in group B than in group A at T3. Conclusion：Administrating N-acetylcysteine during operation can obviously inhibit the ischemia-reperfusion injury in the liver. The possible mechanism are related with eliminating oxygen free radical. Key words ：N-acetylcysteine; Ischemia-reperfusion Injury; Liver(hepatic ischemia reperfusion injury ,HIRI)是肝脏外科手术期间非常严重的并发症,一些长时间的肝门阻断的肝叶切除手术尤其是肝脏移植手术往往会存在肝脏缺血的过程[1],而阻断的血管复通可造成再灌注的损伤,这不利于肝叶切除后肝脏的再生及肝功能的恢复,从而直接影响病人的预后、手术成功率和病人存活率[2]。乙酰半胱氨酸（NAC）对缺血再灌注损伤的心、脑、肾脏、脊髓等器官具有一定的抗氧化作用[2] ,但对于缺血再灌注损伤后的肝脏是否具有抗氧化的保护效应,临床研究尚未见报道。本文拟术中使用NAC,观察肝缺