| Object:Hepatic ischemia-reperfusion injury is common in liver surgery,. HIRI is a dynamic process, the mechanism of which has not been clear now. HIRI pathophysiological procedure. As the most important defensive barrier, hepatic injury induced the endotoxemia with high probability, which in turn aggravate the injured liver to nonfunction, with the result of sepsis as well as multiple organ failure or even to death. The current papers reported that the HIRI as the therapeutic strategies on hepatic ischemia-reperfusion injuries were proved to be Effective. Remote ischemia preconditioning (RIPC), which was Proposed by Przyklenk etc, has been proved to be protective against ischemia-reperfusion injury in heart, brain, liver, spinal cord, kidney etc in many animal studies. Therefore, Clinical trials of RIPC mainly focus on cardiovascular surgery. This study was designed to evaluate the protective role and the probable mechanism of RIPC in hepatic ischemia-reperfusion injuries.Methods:106 liver cancer patients undergoing liver resection were randomly assigned to a control group (n=39), a ischemic preconditioning group(IPC) (n=32), and a RIPC group (n=35) according to the inclusion and exclusion criteria.before operation,The first portal had been blocked for ten minutes and then reperfused for ten minutes before resection in IPC group. hile RIPC consisted of three 5-min tourniquet tied-5-min reperfusion cycles by automated cuff-inflator placed on the right upper arm after anesthesia.â‘ Serum samples for measurements of the concentration of TBIL,TBA,ALB,PAB,ALT,AST,HGB,WBC,PLT were drawn before induction of anesthesia as while as on the 1st,3rd, 7th days after the surgery; The differences between the three groups were analyzed.â‘¡ICGK15 of each group were evalued using DDG Analyser â‘¢Detect the serum TWEAK levels before induction and on the first postoperative day of control group, ICP group and RICP group. Evalue the probable mechanism of them in liver RICP.Results:1. Study of clinic:â‘ Significantly lower serum ALT as well as AST were observed in both IPC and RIPC groups than controls.â‘¡There were no significant differences between the ICGK15 of the patients were not Treated with IPC or RIPC before hepatic-ischemia, and that of patients in control group. (P=0.59>0.05)2. Study of underlying mechanism:Compared with controls, patients treated with IPC showed lower TWEAK levels significantly; there were no significantly differences between the control group and RIPC group, or between IPC group and RIPC group.Conclusion:Our experiment demonstrated that implementation of IPC or RIPC before blocking blood supply to the liver in clinical trials may lower the AST and ALT levels after surgery. And it is lower in IPC group than RIPC group.There were no significantly differences in liver reserve function. The serum TWEAK levels Detected on the first postoperative day of IPC group were lower than the control group significantly, while there were no significantly differences between the control group and RIPC group, or between IPC group and RIPC group. It prompts TWEAK may participate the protection of ischemia-reperfusion injury in IPC and RIPC, the definite mechanism remains further study. |
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