肝脏缺血再灌注损伤(HIRI)是肝切除手术过程中肝损伤的重要原因,是导致手术不成功的重要原因之一,严重影响患者预后。引起HIRI的机制很多,包括炎症反应、氧化应激、细胞凋亡与自噬、线粒体损伤和钙超载等。近年来越来越多的研究表明,围术期的麻醉管理可以减轻炎症、抑制细胞凋亡、缓解氧化应激、防止线粒体损伤,从而改善HIRI。本文总结了近年来国内外针对围术期防治HIRI相关麻醉药物的研究进展,旨在总结HIRI主要病理机制和麻醉药物的作用机制,为未来进一步的临床治疗提供依据。Liver ischemia-reperfusion injury (HIRI) is an important cause of liver injury during liver resection surgery and one of the major reasons for unsuccessful surgery, seriously affecting the prognosis of patients. There are many mechanisms that can cause HIRI, including inflammatory response, oxidative stress, cell apoptosis and autophagy, mitochondrial damage, and calcium overload. In recent years, an increasing number of studies have shown that perioperative anesthesia management can reduce inflammation, inhibit cell apoptosis, alleviate oxidative stress, prevent mitochondrial damage, and thus improve HIRI. This article summarizes the research progress of anesthesia drugs for the prevention and treatment of HIRI during the perioperative period at home and abroad in recent years, aiming to summarize the main pathological mechanisms of HIRI and the mechanisms of action of anesthesia drugs, and provide a basis for further clinical treatment in the future.
在肝脏手术中实现适当的止血仍然是麻醉医生的主要关注点。因此,已经并且仍在开发许多技术来进一步降低失血和输血率。根据最新数据,文章综述的目的是总结在腹腔镜肝脏手术中减少失血量的麻醉管理的最佳可用方法。Proper hemostasis during liver surgery remains a major concern for anesthesiologists. Therefore, many technologies have been and are still being developed to further reduce blood loss and transfusion rates. Based on the latest data, the purpose of this literature review is to summarize the best available methods for anesthesia management to reduce blood loss in laparoscopic liver surgery.
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