The Protective Effect Of Dexmedetomidine On Liver During Liver Tumor Resection

Objective:To investigate the protective effect of dexmedetomidine on perioperative liver in patients undergoing liver tumor resection。Methods:42 patients,aged from 18 to 70 years old,were selected for hepatectomy under general anesthesia,regardless of sex,ASA gradeⅡorⅢ.The patients were randomly divided into two groups:dexmedetomidine group（group D,n=21）and control group（group C,n=21）.The patients in the two groups were anesthetized with the same anesthetic drugs and anesthetic methods,after anesthesia induction,group D was injected with 0.3μg/kg/h dexmetomidine at a no-load dose until 30 minutes before the end of the operation,and group C was injected with equal dose of normal saline at the same time.The dosage of anesthetic was adjusted according to vital signs and bispectral index（BIS）value during operation.The general condition of the patients,sex,age,BMI,ASA grade and so on were recorded.The mean arterial pressure（MAP）,heart rate（HR）and central venous pressure（CVP）were observed and recorded after anesthesia induction（T₀）,skin incision（T₁）,before hepatectomy（T₂）,after hepatectomy（T₃）and suture（T₄）.The levels of lactate（Lac）and blood glucose（Glu）were measured before operation,after hepatectomy and at the end of operation.The total bilirubin（TBil）,indirect bilirubin（IDBil）,alanine aminotransferase（ALT）,aspartate aminotransferase（AST）,creatinine（CR）,prothrombin time（PT）and international standardized ratio（INR）were recorded before operation,1 day after operation（T₁）,2 days after operation（T₂）and 3 days after operation（T₃）.The results of intraoperative operation time,hepatic portal vein occlusion time,blood loss,urine volume,infusion volume,use of pressor drugs,resection size of liver tumor,time of tracheal extubation,postoperative hospital stay and postoperative complications were evaluated and recorded.Results:there was no significant difference in general conditions between two groups（P>0.05）.At T0,there was no significant difference in MAP,HR and CVP between two groups.At T1-T4,the HR in group D was significantly lower than that in group C,but there was no significant difference in MAP and CVP between two groups.The levels of lactic acid and blood glucose in both groups increased after hepatectomy and at the end of operation,but the increase in group D was lower than that in group C（P<0.05）.The levels of Tbil,IDBil,ALT and AST in group C were significantly higher than those in group D at 1 day,2days and 3 days after operation,and the INR at 1 day after operation in group C was significantly higher than that in group D,but there was no significant difference in INR,PT and CR at other time points between two groups.Compared with group C,the number of postoperative complications and the time of tracheal extubation in group D were significantly lower than those in group C（P<0 05）.There was no significant difference in operation time,hepatic portal vein occlusion time,dosage of pressor drugs,blood loss,urine volume,infusion volume,postoperative hospital stay and resection size of liver tumor between the two groups（P>0.05）.Conclusion:Dexmetomidine can reduce the increase of heart rate caused by stress,shorten the time of tracheal extubation and reduce postoperative complications,it can be safely used in liver surgery anesthesia.Dexmetomidine also reduce the level of lactic acid and blood glucose,reduce some blood coagulation indexes,improve liver function,and protect the liver during hepatectomy.