Study On Epidural Block Relieving Hepatic Ischemia-reperfusion Injury And The Mechanism

Objective:The aim of this study was to investigate whether epidural block can alleviate hepatic ischemia-reperfusion injury?HIRI?in patients undergoing laparoscopic left partial hepatectomy under hepatic hilar obstruction,and investigate its possible mechanism as well as,which may provide a reference for clinical rational choice of anesthetic mode and administration.Methods:A total 60 patients aged 35-65,with no serious heart and lung disease,body mass index?BMI?from 18.0 to 25.0,ASA grade I or II,normal preoperative liver and kidney function as well as liver function Child-Pugh score<7 points?grade A?,were selected for left intrahepatic bile duct stone hospitalization and underwent partial laparoscopic left hepatectomy under hepatic occlusion?Pringle method?from July 2016 to February 2018.These cases were divideed into two groups:GA group,?General anesthesia group?,GE group(General anesthesia combined with epidural block group.The level of?T₁?before skin incision,?T₂?before hepatic hilar opening,?T₃?1h,?T₄?2h,?T₅?6h,?T₆?24h of the two groups and serum after ischemia,alanine aminotransferase?ALT?,aspartate aminotransferase?AST?,superoxide dismutase?SOD?and malondialdehyde?MDA?,IL-6,TNF-?were detected.Results:1.General information:There was no statistically significant difference in general conditions of age,sex ratio,BMI,the weight of resected liver tissue,the time of hepatic hilus occlusion,the amount of blood loss and the duration of operation in the two groups.?P>0.05?;2.There was no significant difference in serum ALT and AST levels between the two groups at T1 time.?P>0.05?;From T₂-T₆,the levels of ALT and AST in the serum of the two groups began to increase significantly,and the difference was statistically significant.?P<0.05?;DuringT₂ to T₆,although the increasing trend of serum ALT and AST levels in GE group was similar to that in GA group,but the serum levels of ALT and AST in GE group were significantly lower than those in GA group at the same time,and the difference was statistically significant.?P<0.05?.3.At T₁?T₂,there was no significant difference in MDA and SOD levels of serum between the two groups.?P>0.05?;At T₃ to T₅,the serum MDA levels in the two groups were higher than those in the group of T₁?T₂,and the difference was statistically significant.?P<0.05?;At T₃ to T₅,the serum MDA level of patients in group GE group was similar to that in GA group,but the serum MDA level in GE group was lower than that in GA group at the same period,and the difference was statistically significant.?P<0.05?;At T₆,the serum MDA level of patients in two groups was down to the level at T₁ and T₂,and the difference between the two groups was not statistically significant.?P>0.05?;At T₃ to T₅,serum SOD levels in the two groups were lower than those in T₁?T₂,and the difference was statistically significant.?P<0.05?;At T₃ to T₅,the serum SOD level of patients in GE group was similar to that in GA group,but the serum SOD level in GE group was higher than that in GA group at the same period,and the difference was statistically significant.?P<0.05?.At T₆,the serum SOD level of patients in two groups was down to the level at T₁ and T₂,and the difference between the two groups was not statistically significant.?P>0.05?.4.There was no significant difference in serum levels of IL-6 and TNF-?between the two groups at the time of T₁.?P>0.05?;at the time of T₂ to T₆,The levels of IL-6 and TNF-?were significantly increased,and the difference was statistically significant.?P<0.05?.the serum level of IL-6 and TNF-?in GE group was similar to that in GA group,but the serum IL-6 and TNF-?level in GE group was higher than that in GA group at the same period,and the difference was statistically significant.?P<0.05?.Conclusion:Epidural block can alleviate HIRI to patients undergoing laparoscopic left hepatectomy under hepatic hilar obstruction,and its mechanism may be related to its inhibition of inflammation during hepatic ischemia and reperfusion.