远程缺血预处理对肝切除术患者肝损伤的影响：ERIC-LIVER 试验。

Effect of remote ischemic preConditioning on liver injury in patients undergoing liver resection: the ERIC-LIVER trial.

机构信息

Department of Hepato-pancreato-biliary and Transplant Surgery, Singapore General Hospital, Singapore.

Department of Emergency Medicine, Singapore General Hospital, Singapore; SingHealth Duke-NUS Emergency Medicine Academic Clinical Programme, Singapore; Cardiovascular & Metabolic Disorders Program, Duke-National University of Singapore Medical School, Singapore; National Heart Research Institute Singapore, National Heart Centre, Singapore.

出版信息

HPB (Oxford). 2020 Sep;22(9):1250-1257. doi: 10.1016/j.hpb.2019.12.002. Epub 2020 Jan 30.

DOI:10.1016/j.hpb.2019.12.002

PMID:32007393

Abstract

OBJECTIVE

Novel hepatoprotective strategies are needed to improve clinical outcomes during liver surgery. There is mixed data on the role of remote ischemic preconditioning (RIPC). We investigated RIPC in partial hepatectomy for primary hepatocellular carcinoma (HCC).

METHODS

This was a Phase II, single-center, sham-controlled, randomized controlled trial (RCT). The primary hypothesis was that RIPC would reduce acute liver injury following surgery indicated by serum alanine transferase (ALT) 24 h following hepatectomy in patients with primary HCC, compared to sham. Patients were randomized to receive either four cycles of 5 min/5 min arm cuff inflation/deflation immediately prior to surgery, or sham. Secondary endpoints included clinical, biochemical and pathological outcomes. Liver function measured by Indocyanine Green pulse densitometry was performed in a subset of patients.

RESULTS

24 and 26 patients were randomized to RIPC and control groups respectively. The groups were balanced for baseline characteristics, except the duration of operation was longer in the RIPC group. Median ALT at 24 h was similar between groups (196 IU/L IQR 113.5-419.5 versus 172.5 IU/L IQR 115-298 respectively, p = 0.61). Groups were similar in secondary endpoints.

CONCLUSION

This RCT did not demonstrate beneficial effects with RIPC on serum ALT levels 24 h after partial hepatectomy.

摘要

目的

需要新的肝保护策略来改善肝切除术中的临床结果。关于远程缺血预处理（RIPC）的作用存在混合数据。我们研究了 RIPC 在原发性肝细胞癌（HCC）部分肝切除术中的作用。

方法

这是一项 II 期、单中心、假对照、随机对照试验（RCT）。主要假设是，与假手术相比，RIPC 会降低原发性 HCC 患者手术后 24 小时内血清丙氨酸转氨酶（ALT）指示的急性肝损伤。患者随机分为接受手术前立即进行 4 个周期的 5 分钟/5 分钟手臂袖带充气/放气，或假手术。次要终点包括临床、生化和病理结果。在部分患者中进行了吲哚菁绿脉冲密度测定以测量肝功能。