Chen Ming-yi, Li Chong-hui, Huang Zhi-qiang, Liu Ju-chao, Zhou Ning-xin, Huang Xiao-qiang, Wang Yan-sheng
Department of Hepatobiliary Surgery, General Surgical Research Institute, Chinese People's Liberation Army General Hospital, Beijing 100853, China.
Chin Med J (Engl). 2004 Feb;117(2):275-9.
Ischemia-reperfusion (IR) injury to the liver is still a critical and daunting problem in the field of hepatobiliary surgery. Ischemic preconditioning (IP) of the liver serves as an effective approach against IR injury. This study was to develop a novel procedure that could mimic IP, but might be more feasible than IP during surgery.
Eighty-two SD rats were randomly divided into 5 groups. L group (n = 21): 0.4% lidocaine (10 mg/kg) was injected into the hepatoduodenal ligament 10 minutes before a 40-minute hepatic IR. IP group (n = 16): a 5-minute ischemia was followed by a 10-minute reperfusion prior to a 40-minute hepatic IR. ILR group (n = 15): after a 40-minute ischemia of the liver, 0.4% lidocaine (10 mg/kg) was injected into the hepatoduodenal ligament 10 minutes prior to a 40-minute reperfusion of the liver. IR group (n = 15): the liver of the rat was subjected to a 40-minute IR. Control group (n = 15): 0.9% sodium chloride was injected into the hepatoduodenal ligament without other treatments. The levels of plasma alanine transaminase (ALT) and aspartate transaminase (AST) were determined for each group after treatment.
The mean concentrations of ALT and AST were (379.80 +/- 141.69) U/L and (606.05 +/- 220.26) U/L for the L group, (334.64 +/- 141.94) U/L and (625.68 +/- 267.06) U/L for the IP group, (523.36 +/- 170.35) U/L and (765.47 +/- 238.45) U/L for the ILP group, (524.29 +/- 163.59) U/L and (764.63 +/- 246.79) U/L for the IR group, and (150.90 +/- 27.05) U/L and (298.15 +/- 47.68) U/L for the control group (standard error of the mean).
A significant decrease in ALT and AST levels was observed in the L and IP groups when compared to the ILR and IR groups (P < 0.05), but no significant difference in ALT and AST levels was observed in the L group when compared to the IP group (P > 0.05). These results suggest that pretreatment with lidocaine injected into the hepatoduodenal ligament prior to IR provides effective protection against subsequent IR injury to the liver. The novel approach of blocking innervation with lidocaine mimics hepatic IP, but is more convenient than IP at the time of liver surgery.
肝脏缺血再灌注（IR）损伤仍是肝胆外科领域一个关键且棘手的问题。肝脏缺血预处理（IP）是对抗IR损伤的一种有效方法。本研究旨在开发一种能模拟IP但在手术中可能比IP更可行的新方法。
82只SD大鼠随机分为5组。L组（n = 21）：在40分钟肝脏IR前10分钟，将0.4%利多卡因（10mg/kg）注入肝十二指肠韧带。IP组（n = 16）：在40分钟肝脏IR前，先进行5分钟缺血，接着10分钟再灌注。ILR组（n = 15）：肝脏缺血40分钟后，在肝脏再灌注40分钟前10分钟，将0.4%利多卡因（10mg/kg）注入肝十二指肠韧带。IR组（n = 15）：大鼠肝脏进行40分钟IR。对照组（n = 15）：将0.9%氯化钠注入肝十二指肠韧带，无其他处理。处理后测定每组血浆丙氨酸转氨酶（ALT）和天冬氨酸转氨酶（AST）水平。
L组ALT和AST的平均浓度分别为（379.80±141.69）U/L和（606.05±220.26）U/L；IP组分别为（334.64±141.94）U/L和（625.68±267.06）U/L；ILP组分别为（523.36±170.35）U/L和（765.47±238.45）U/L；IR组分别为（524.29±163.59）U/L和（764.63±246.79）U/L；对照组分别为（150.90±27.05）U/L和（298.15±47.68）U/L（均值标准误）。
与ILR组和IR组相比，L组和IP组的ALT和AST水平显著降低（P < 0.05），但L组与IP组的ALT和AST水平无显著差异（P > 0.05）。这些结果表明，在IR前将利多卡因注入肝十二指肠韧带进行预处理可有效保护肝脏免受随后的IR损伤。用利多卡因阻断神经支配的新方法模拟了肝脏IP，但在肝脏手术时比IP更方便。
