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Metalloproteinase expression after desflurane preconditioning in hepatectomies:A randomized clinical trial

World Journal of Hepatology 2020年第11期12卷 1098-1114页

作者： Eleni Koraki Ioannis Mantzoros Christos Chatzakis Anna Gkiouliava Angeliki Cheva Athina Lavrentieva Freideriki Sifaki Helena Argiriadou Isaak Kesisoglou konstantinos galanos-demiris Stefanos Bitsianis konstantinos Tsalis Department of Anaesthesiology “G Papanikolaou”General HospitalThessaloniki 57010Greece Fourth Department of Surgery Medical SchoolAristotle University of ThessalonikiThessaloniki 57010Greece Department of Pathology Medical SchoolAristotle University of ThessalonikiThessaloniki 54636Greece First Department of Intensive Care Unit "G Papanikolaou"General HospitalThessaloniki 57010Greece Department of Anaesthesiology and Intensive Care Unit Aristotle University of ThessalonikiAHEPA University HospitalThessaloniki 54636Greece Third Department of Surgery Aristotle University of ThessalonikiAHEPA University HospitalThessaloniki 54636Greece

BACKGROUND Hepatectomy with inflow occlusion results in ischemia-reperfusion injury;however,pharmacological preconditioning can prevent such injury and optimize the postoperative recovery of hepatectomized *** normal inflammatory response after a hepatectomy involves increased expression of metalloproteinases,which may signal pathologic hepatic tissue *** To investigate the effect of desflurane preconditioning on these inflammatory indices in patients with inflow occlusion undergoing *** This is a single-center,prospective,randomized controlled trial conducted at the 4th Department of Surgery of the Medical School of Aristotle University of Thessaloniki,between August 2016 and December ***-six patients were randomized to either the desflurane treatment group for pharmacological preconditioning(by replacement of propofol with desflurane,administered 30 min before induction of ischemia)or the control group for standard intravenous *** primary endpoint of expression levels of matrix metalloproteinases and their inhibitors was determined preoperatively and at 30 min posthepatic *** secondary endpoints of neutrophil infiltration,coagulation profile,activity of antithrombin III(AT III),protein C(PC),protein S and biochemical markers of liver function were determined for 5 d postoperatively and compared between the *** The desflurane treatment group showed significantly increased levels of tissue inhibitor of metalloproteinases 1 and 2,significantly decreased levels of matrix metalloproteinases 2 and 9,decreased neutrophil infiltration,and less profound changes in the coagulation *** the 5-d postoperative period,all patients showed significantly decreased activity of AT III,PC and protein S(vs baseline values,P<0.05).The activity of AT III and PC differed significantly between the two groups from postoperative day 1 to postoperative day 5(P<0.05),showing a moderate drop in activity of AT

关键词： Desflurane Preconditioning Hepatectomy Inflammation Metalloproteinases Reperfusion injury

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