| Objective In recent years, the rise of research in the liver to protect the drug pretreatment increased attention, some of the liver protective effect of anesthetic preconditioning have been studies confirmed. In this study, patients with right liver resection as the research object of sevoflurane preconditioning on hepatic ischemia-reperfusion injury in patients and its part of the mechanism for in-depth study of inhalational anesthetics on hepatic ischemia-reperfusion injury in rats lay a certain foundation.Methods 40 cases of elective liver resection in patients with the right line, ASA I or II level, surgery through the first portal triad clamping, blood flow occlusion time 10 ~ 30min. Were randomly divided into two groups: control group (C group) and sevoflurane preconditioning group (S group), 20 patients in each group. All patients routine preoperative fasting 6h, water deprivation 2h. 30min before anesthesia intramuscular midazolam 2mg and hydrochloric acid penehyclidine 0.5mg. After the break-open the left upper extremity venous access, routine monitoring of ECG, mean arterial pressure (MAP), pulse oxygen saturation (SpO2) and the bispectral index. Induction of anesthesia: intravenous injection of midazolam 0.08 ~ 0.10mg/kg, etomidate 0.2 ~ 0.3mg/kg, fentanyl 8 ~ 10μg/kg and rocuronium 0.6 ~ 0.8mg/kg, after intubation OK intermittent positive pressure mechanical ventilation (tidal volume of 8 ~ 10ml/kg, respiratory rate 12 times/min, suction call ratio 1:1.5, oxygen flow 2L/min), to maintain end-expiratory carbon dioxide (PETCO2) 3.99 ~ 4.66kpa。The left radial artery catheterization for monitoring the MAP, the right internal jugular vein catheterization for blood collection. S group, after anesthesia induction and tracheal intubation to open sevoflurane vaporizer, regulating the concentration and oxygen inhalation flow rate, so that patients with end-tidal sevoflurane concentration quickly reached 1.0MAC value, and continued to wash out after 30min to Pringle started; C group without any inhaled anesthetics. Two groups of patients under anesthesia during the bispectral index (BIS40-50), hemodynamic changes, surgical stimulus intensity intermittent intravenous fentanyl, midazolam, vecuronium to maintain depth of anesthesia. Intraoperative intravenous infusion of lactated Ringer's solution and hydroxyethyl starch 130/0.4 and sodium chloride injection 10 ~ 12ml/ (kg·h), additional blood loss and loss of fluid volume, crystal-cement ratio of 1:1, if necessary, injection of Nepal Card horizon or phenylephrine to maintain a stable HR and MAP to baseline fluctuations of no more than 20%, when Hb <80g /L or Hct <24%, the on-demand infusion of red blood cell suspension. Before induction of anesthesia (T0), Pringle immediately (T1), hepatic portal, opening up instantly (T2), ischemia/reperfusion 1h (T3), 6h (T4), 24h (T5) Measurement of serum alanine aminotransferase ( ALT), aspartate aminotransferase (AST), lactate dehydrogenase (LDH), TNF-α, IL-1 levels, as well as ischemia/reperfusion 1h liver tissue homogenate malondialdehyde (MDA) content and superoxide dismutase dismutase (SOD) activity, liver histopathology observed in parallel.Result With the induction of anesthesia comparison, the two groups in the hepatic portal open instantly, ischemia / reperfusion after 1h,6 h, 24h of serum ALT, AST, LDH, TNF-α, IL-1 levels were significantly increased (P <0.05); compared with the C group, S group in the hepatic portal open instantly, ischemia/reperfusion the corresponding time points of serum ALT, AST, LDH, TNF-α, IL-1 levels were lower (P<0.05); ischemia/re - 1h after reperfusion of liver homogenate MDA content decreased, SOD activity increased (P <0.05), liver Conclusion1. Sevoflurane preconditioning can protect right liver operation from ischemia reperfusion injury.2. The protective mechanisms maybe(1) related to reduceing the release of oxyradical and inhibiting the lipid peroxidation;(2) related to reduceing inflammatory response and inhibition to reduce the generation of inflammatory factors.
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