Effect Of Alprostadil On Stress Response Of Perioperative Period And Early Phase Liver Function After Hepatectomy

Objective: To evaluate the effect of alprostadil on stress response of perioperative and early phase liver function after hepatectomy.Methods: We assigned 32 ASA I-â…¡patients of liver cancer, aged 47-62years old and weighed 55-76kg who underwent partial hepatectomy .Thirty-two patients were divided randomly into two groups controlled group (group C)and alprostadil group(group P). Both groups were all received total intravenous anesthesia and postoperative conventional therapy .They are connected to routine monitors electrocardiogram (ECG),saturation pulse oxygen (Spo2).All patients received premedication with Atropine 0.5mg muscle injection in 30 min before anesthesia and LR (Lactate Ringers Injection) was refused 8^-10ml/kg before induction. For induction, Midazolam 0.1mg.kg^-1, Etomidate 0.3mg.kg^-1,Sufentanil 0.5ug.kg^-1,Atra-curium 0.5mg.kg^-1 was injected. Continous infusion of Remifentanil (rate 0.2ug.kg^-1min^-1),Atracurium (rate 0.5mg.kg^-1.h^-1) and Propofol (rate 5mg.kg^-1.h^-1) was administered for maintenance of anesthesia. Before intubaion group P received a bolus injection of alprostadil 0.3ug.kg^-1 followed by a continous infusion of the same drug (3ng.kg^-1.min^-1),. In addition, alprostadil was infused with 20μg continuous infusion postoperative, three times every day in the Group P. While Group C received saline only .SBP,DBP,HR,SpO2,ECG,PETCO2 were monitored continuously during anesthesia . SBP,DBP and HR were recorded at 2 minutes before intubation (T0),the moment after intubation (T₁),5 minutes after intubation(T₂),15 minutes after intubation(T₃), Epinephrine (E) and norepinephrine (NE) were determimated at T0, T₁,T₂,T₃ with venous blood. Observed the changes of vital signs and serum total bilirubin (TBIL), alanine aminotransferase (ALT),γGlu GGT (γ-gt), prothrombin time (PT) were measured at the time points of day 0, 1,3,5,7 postoperative. C-reactive protein (CRP) and cortisol levels (COR) in all cases were determined pre-and post-operatively. Results:1.Hemodynamics:Systemic blood pressure (SBP), diastolic blood pressure (DBP) and heat rate(HR) at T₁ and T₂ of group C were both significantly higher than that at T0 which showed statistically differences(p<0.05).There was no significant differences between SBP,DBP,HR of two groups at T0 and T₃ (p>0.05). Systemic blood pressure( SBP),diastolic blood pressure(DBP)and heat rate(HR) at T₁ and T₂ of group C were both significantly higher than that of group P which showed statistically differences(p<0.05).2.Catecholamine.Catecholamine (NE and E) increased at T₁, T₂, T₃ in two groups, which was significantly different compared with T0 (P<0.05) .There was no significant differences between group P and group C at T0 (p>0.05). At T₁, T₂, in group P the increase of catecholamine is lower than group C, which is significantly different from group C.3.Liver functionPatients in both groups were no significant differences in vital signs. There were no significant differences on serum levels of total bilirubin and ALT,γ-gt, PT immediately after operation between two groups. Compared with 0 days, the levels of serum total bilirubin, ALT,γ-gt, and PT were higher on day 1,3,5,7 in the two groups,and there was a downward trend after the fifth day. Compared with the control group, the levels of serum total bilirubin, ALT,γ-gt and PT were decreased in the treated group, the difference was statistically cant.4.C-reactive protein (CRP) and cortisol levels (COR)C-reactive protein (CRP) and cortisol concentrations increased on first postoperative day only in group C. (p<0.01).CRP returned preoperative status on third postoperative day and COR returned preoperative status on fifth postoperative day. There were no significant differences on CRP and COR in group P.Conclusion:In the appropriate depth of anesthesia , alprostadil can inhibit the secretion of catecholamine so that it can has an anti-stress effect to some extent .Continous infusion of alprostadil pre-operative and post-operative can reduce liver injury, and restore liver function and play a protective role after hepatectomy.