Fayed Nirmeen A, Sayed Eman I, Saleh Sherif M, Ehsan Nermen A, Elfert Ashraf Y
Anesthesia and Intensive Care, National Liver Institute, Menoufia University, ShebeenAlkoom, Menoufia, Egypt.
Hepatobiliary Surgery, National Liver Institute, Menoufia University, ShebeenAlkoom, Menoufia, Egypt.
Clin Transplant. 2016 Apr;30(4):470-82. doi: 10.1111/ctr.12713. Epub 2016 Mar 3.
The aim of this study was to investigate the hypothesis that intraoperative infusion of dexmedetomidine can exert a protective effect against hepatic ischemia-reperfusion injury (IRI) in adult living donor liver transplantation (LDLiver transplantation).
Forty recipients were allocated into: control group (group I; n = 20) that received a placebo; and dexmedetomidine group (group II; n = 20) that received a continuous intraoperative infusion of 0.8 μg/kg/h of dexmedetomidine. Data collected were AST, ALT, bilirubin, INR, and lactate, at baseline, immediately post-operatively, and on post-operative days 1, 3, and 5. Intercellular adhesion molecule-1 (ICAM-1) was measured at: baseline, 2 and 6 h after reperfusion, and on post-operative day 1. At the end of the surgery, a liver biopsy was sent for histopathological assessment.
No significant difference was noticed in either group regarding MELD score, baseline AST, ALT, bilirubin, INR, or lactate. Dexmedetomidine tended to decrease blood pressure and heart rate, but the comparison was insignificant. Group II showed significantly attenuated levels of ICAM-1 and significantly minimal histopathological changes. The laboratory changes showed significantly lower AST, ALT, bilirubin, INR, and lactate in group II.
Dexmedetomidine exerted protective effects against hepatic IRI during adult LDLiver transplantation, as indicated by suppression of ICAM-1, better scores of histopathological assessment, and augmented post-operative liver function tests.
本研究旨在探讨术中输注右美托咪定对成人活体肝移植中肝缺血再灌注损伤（IRI）具有保护作用这一假说。
40例受者被分为：对照组（I组；n = 20），接受安慰剂；右美托咪定组（II组；n = 20），术中持续输注0.8μg/kg/h的右美托咪定。收集在基线、术后即刻、术后第1、3和5天收集的数据包括谷草转氨酶（AST）、谷丙转氨酶（ALT）、胆红素、国际标准化比值（INR）和乳酸。在基线、再灌注后2小时和6小时以及术后第1天测量细胞间黏附分子-1（ICAM-1）。手术结束时，取肝组织活检进行组织病理学评估。
两组在终末期肝病模型（MELD）评分、基线AST、ALT、胆红素、INR或乳酸方面均未发现显著差异。右美托咪定有降低血压和心率的趋势，但比较无统计学意义。II组ICAM-1水平显著降低，组织病理学变化显著轻微。实验室检查结果显示，II组AST、ALT、胆红素、INR和乳酸水平显著降低。
右美托咪定在成人活体肝移植期间对肝IRI发挥了保护作用，表现为ICAM-1受到抑制、组织病理学评估评分更佳以及术后肝功能检查结果改善。
