Effect Of Limb Remote Ischemic Preconditioning On Liver Function In Patients With Hepatic Hydatid Disease After Hepatectomy At High Altitude

Objective Patients with hepatic alveolar echinococcosis(HAE)can obtain a better long-term survival rate by the performance of hepatectomy,but this is associated with severe incidence rate and mortality of ischemia reperfusion(IR)injury.Remote ischemic preconditioning(RIPC)can exert an effect which can reduce IR injury,but there is a controversy on this view.A randomized controlled study in Qinghai Provincial People’s Hospital was conducted to assess the effect of RIPC on postoperative liver function in patients undergoing hepatectomy.Method Sixty patients with HAE at high altitude who underwent elective partial hepatectomy were selected and randomly divided into two groups,including 30 in RIPC group(group R),and the remaining 30 in control group(group C).Patients in group R were performed with RIPC,that is 5 minutes of ischemia and 5 minutes of reperfusion,a total of 3 cycles.By contrast,group C did not do any processing.Some indexes were measured the day before the operation,10 minutes before porta hepatis vascular occlusion(T0),1 hour after porta hepatis vascular opening(T1),6 hours after porta hepatis vascular opening(T2)and 24 hours after porta hepatis vascular opening(T3),including the levels of serum alanine aminotransferase(ALT),aspartate aminotransferase(AST)and total bilirubin(TBIL),in order to measure the dynamic changes of liver function.The degree of hepatocyte injury was assesed by another indicator,that is the level of serum lactate dehydrogenase(LDH),which was measured the day before and after the operation.Furthermore,the occurrence of postoperative complications,postoperative hospitalization days and 30-day mortality were recorded.Result Both groups had similar indicators in the day before the operation and T0 time point,that is no significant difference between groups.Compared with group C,group R had lower levels of ALT and AST in T2 and T3 time points,lower levels of TBIL in T2 time point and lower levels of LDH in the day after the operation.When taking account of the occurrence of postoperative complications,postoperative hospitalization days and 30-day mortality,this study did not show a difference between both groups.Conclusion RIPC has a protective effect on hepatic IR injury to a certain extent.This conclusion can be confirmed by a better liver function after operation in group R.