Effect Of Dexmedetomidine Combined With Remote Limb Ischemic Preconditioning On Hepatic Ischemic-reperfusion Injury In Patients Undergoing Liver Resection Surgery

Objective: To investigate the effect of remote limb ischemic preconditioning and dexmedetomidine on liver ischemia-reperfusion injury,and evaluate its clinical application value,so as to provide practical basis for future clinical treatment.Methods:A total of 80 patients with hepatolithiasis who were to undergo laparoscopic left hepatectomy under an elective or limited period were selected.The patients were randomly divided into 4 groups(n = 20):control group(Group C),dexmedetomidine group(Group D),remote ischemic preconditioning group(group R),dexmedetomidine combined with ischemic preconditioning group(group DR).In group D,10 minutes after tracheal intubation,dexmedetomidine was pumped at a loading dose of 1ug/kg for 15 minutes,and then intravenously pumped until the end of the operation,the dose was 0.5ug/kg/h.In group R,the left lower limb ischemic preconditioning was performed with 10 min after endotracheal intubation.The automatic pneumatic tourniquet was fastened to the root of the thigh of the left lower limb,and the pressure was set to 200 mm Hg(1mm Hg = 0.133 k Pa).Make the left lower limb ischemic(the successful standard of ischemia: the pulse of the dorsalis pedis artery of the left lower limb could not be touched).Inflated continuously with 5min and then deflated to 0mm Hg to restore the blood flow,continued 5min,the above operation process is repeated 3 times,a total of 30 min.Group C was infused with the same amount of 0.9% sodium chloride injection as that of Group D,and the left lower limb was fastened with a tourniquet without inflatable treatment.The group DR used the method of group D and group R at the same time.The gender,age,height,weight,hepatic occlusion time,operation time,intraoperative blood transfusion,blood loss and urine volume of all patients were recorded;respectively before operation(T0),2 hours(T1),4 hours(T2)after reperfusion collect venous blood to detect serum IL-1 and TNF-α concentrations;then draw venous blood before operation(T0),the first day after the operation(T3),the third day(T4)and the seventh day(T5)after the operation to detect the concentration of serum ALT,AST,bilirubin(including TBIL,DBIL,IBIL)and albumin.Results:(1).Comparison of TBIL,DBIL and IBIL among the four groups of patients: Intra-group comparison: Compared with T0,the serum TBIL,DBIL,and IBIL concentrations of the four groups of patients at T3 and T4 have statistically significant differences(P>0.05),and there is no statistical significance between the groups at the T5 time point(P>0.05).Comparison of each group: Compared with group C,the differences in serum TBIL,DBIL,and IBIL concentrations at T3 in group D,group R and group DR were statistically significant(P<0.05),compared between groups at T4 and T5 time points the difference was not statistically differenct(P>0.05).(2).Comparison of the albumin of the four groups of patients:Compared with T0,the albumin of the four groups of patients decreased at T3,T4,and T5(P<0.05);there was no statistical difference between the groups(P>0.05).(3).Comparison of AST and ALT of four groups of patients:Intra-group comparison: The serum AST and ALT levels of T3,T4 and T5 in the four groups were significantly higher than those before operation(P < 0.05).Comparison of each group: Compared with group C,the serum AST and ALT concentrations of group D,group R,and group DR decreased at each time point of T3,T4,and T5(P<0.05);compared with group D and R,the serum AST and ALT in T3 were decreased in group DR(P<0.05);there was not significantly different between group D and group R(P>0.05).(4).Comparison of TNF-α and IL-1 among the four groups of patients:Intra-group comparison: Compared with T0,the serum TNF-αand IL-1 concentrations at T1 and T2 in the four groups were significantly increased(P<0.05).Comparison of each group: The serum TNF-α and IL-1 concentrations in group D,group R,and group DR all decreased at T1,compared with group C(P<0.05),and the serum TNF-α and IL-1 concentrations in group D and group DR decreased at T2(P<0.05);compared with group D and group R,respectively,The serum TNF-α and IL-1 concentrations in the DR group decreased at the T1 time point(P<0.05);there was not significantly different between the group D and the group R(P>0.05).Conclusions:(1).In patients undergoing laparoscopic left hepatectomy for the treatment of hepatolithiasis,dexmedetomidine,remote ischemic preconditioning and their combination can reduce HIRI.(2).The effect of dexmedetomidine combined with remote ischemic preconditioning on hepatic ischemia-reperfusion injury after laparoscopic left hepatectomy is better than the two alone.