Application of remote ischemic preconditioning combined with controlled low central venous pressure in hepatectomy

Yuansong GAO; Liu YANG; You WU; Na ZHANG; Chun TIAN

doi:10.3969/j.issn.1001-5256.2023.04.017

Volume 39 Issue 4

Apr. 2023

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Article Navigation > Journal of Clinical Hepatology > 2023 > 39(4): 856-863

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Application of remote ischemic preconditioning combined with controlled low central venous pressure in hepatectomy

DOI: 10.3969/j.issn.1001-5256.2023.04.017

Department of Anesthesiology, Yongchuan Hospital Affiliated to Chongqing Medical University, Chongqing 402160, China

Research funding:

Chongqing Municipal Science and Health Joint Medical Research Project of China (2020FYYX033);

The Science Foundation of Yongchuan, Chongqing (Ycstc);

The Science Foundation of Yongchuan, Chongqing (2020nb0229)

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Corresponding author: TIAN Chun, Tianchun314@163.com (ORCID: 0000-0001-9107-167X)
Received Date: 2022-08-26
Accepted Date: 2022-09-26
Published Date: 2023-04-20

Abstract

Abstract

Objective To investigate the application effect of remote ischemic preconditioning (RIPC) combined with controlled low central venous pressure (CLCVP) in hepatectomy. Methods A total of 80 patients who underwent elective partial hepatectomy in Yougchuan Hospital Affiliated to Chongqing Medical University from May 2021 to April 2022 were enrolled and divided into control group (group C), CLCVP group (group L), RIPC group (group R), and RIPC+CLCVP group (group RL) using a random number table, with 20 patients in each group. The patients in group L received CLCVP, those in group R received RIPC, and those in group RL received both CLCVP and RIPC. The patients were compared in terms of perioperative general status and the levels of tumor necrosis factor-α (TNFα), alanine aminotransferase (ALT), aspartate aminotransferase (AST), and total bilirubin on preoperative day 1(D0), postoperative day 1(D1), postoperative day 3(D3), postoperative day 5(D5), and postoperative day 7(D7). A one-way analysis of variance or a repeated measures analysis of variance was used for comparison of normally distributed continuous data between groups, and the Kruskal-Wallis H test was used for comparison of continuous data with skewed distribution between groups; the chi-square test was used for comparison of categorical data. Results Compared with group R, group RL had a significantly shorter time of operation (H=14.278, P=0.015), a significantly lower total infusion volume (H=24.175, P=0.001), and a significantly lower estimated blood loss (H=45.625, P < 0.001). Group and time factors had significant interaction effects on TNFα, ALT, and AST in the four groups (P < 0.001; P=0.010; P=0.012). Group RL had a significantly lower level of TNFα than group L on D1(P < 0.001) and D3(P < 0.001). Group RL had a significantly lower level of ALT than group L on D1(P=0.008) and D7(P < 0.001). Conclusion For patients undergoing hepatectomy, RIPC combined with CLCVP can effectively reduce intraoperative blood loss, provide a clear surgical field, and shorten the time of operation; meanwhile, it can also inhibit inflammatory response by reducing TNFα, but it cannot effectively alleviate hepatic ischemia-reperfusion injury after hepatectomy under the context of CLCVP.
- Ischemic Preconditioning,
- Central Venous Pressure,
- Reperfusion Injury,
- Hepatectomy

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References(33)

References

[1]	SUNG H, FERLAY J, SIEGEL RL, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries[J]. CA Cancer J Clin, 2021, 71(3): 209-249. DOI: 10.3322/caac.21660.
[2]	General Office of National Health Commission. Standard for diagnosis and treatment of primary liver cancer(2022 edition)[J]. J Clin Hepatol, 2022, 38(2): 288-303. DOI: 10.3969/j.issn.1001-5256.2022.02.009. 国家卫生健康委办公厅. 原发性肝癌诊疗指南(2022年版)[J]. 临床肝胆病杂志, 2022, 38(2): 288-303. DOI: 10.3969/j.issn.1001-5256.2022.02.009.
[3]	SUN Z, SHAO WW, SONG JH. Progress in diagnosis and treatment of hepatocellular carcinoma with microvascular invasion[J/OL]. Chin J Hepat Surg(Electronic Edition), 2021, 10(3): 235-241. DOI: 10.3877/cma.j.issn.2095-3232.2021.03.002. 孙振, 邵巍伟, 宋京海. 肝细胞癌合并微血管侵犯的诊疗进展[J/OL]. 中华肝脏外科手术学电子杂志, 2021, 10(3): 235-241. DOI: 10.3877/cma.j.issn.2095-3232.2021.03.002.
[4]	WANG KJ, HUANG ZH, SHI QL, et al. Research progress of precise hepatectomy for hepatocellular carcinoma[J]. China Med Herald, 2021, 18(23): 43-46. https://www.cnki.com.cn/Article/CJFDTOTAL-YYCY202123010.htm 王克净, 黄祖鸿, 石清兰, 等. 肝细胞癌精准肝切除的研究进展[J]. 中国医药导报, 2021, 18(23): 43-46. https://www.cnki.com.cn/Article/CJFDTOTAL-YYCY202123010.htm
[5]	RIPAMONTI L, DE CARLIS R, LAUTERIO A, et al. Major hepatectomy for perihilar cholangiocarcinoma in elderly patients: is it reasonable?[J]. Updates Surg, 2022, 74(1): 203-211. DOI: 10.1007/s13304-021-01111-6.
[6]	HOJO A, NAKAYAMA H, OKAMURA Y, et al. Evaluation of safety-related outcomes of one-segment and more-than-one-segment high-level hepatectomy in hepatocellular carcinoma based on the japanese board certification system[J]. World J Surg, 2022, 46(5): 1141-1150. DOI: 10.1007/s00268-022-06467-3.
[7]	JUNRUNGSEE S, SUWANNIKOM K, TIYAPRASERTKUL W, et al. Efficacy and safety of infrahepatic inferior vena cava clamping under controlled central venous pressure for reducing blood loss during hepatectomy: A randomized controlled trial[J]. J Hepatobiliary Pancreat Sci, 2021, 28(7): 604-616. DOI: 10.1002/jhbp.969.
[8]	SHI HZ, XIONG QR, XIA J, et al. Application of controlled low central venous pressure in laparoscopic hepatectomy for patients with primary liver cancer and posthepatitis cirrhosis[J]. Chin J Gen Surg, 2020, 29(1): 27-34. DOI: 10.7659/j.issn.1005-6947.2020.01.004. 史惠中, 熊奇如, 夏俊, 等. 控制性低中心静脉压在原发性肝癌伴肝炎后肝硬化患者腹腔镜肝切除中的应用[J]. 中国普通外科杂志, 2020, 29(1): 27-34. DOI: 10.7659/j.issn.1005-6947.2020.01.004.
[9]	WU G, CHEN M, WANG X, et al. Effect of remote ischemic preconditioning on hepatic ischemia-reperfusion injury in patients undergoing liver resection: a randomized controlled trial[J]. Minerva Anestesiol, 2020, 86(3): 252-260. DOI: 10.23736/S0375-9393.19.13838-2.
[10]	TEO JY, HO A, BULLUCK H, et al. Effect of remote ischemic preConditioning on liver injury in patients undergoing liver resection: the ERIC-LIVER trial[J]. HPB(Oxford), 2020, 22(9): 1250-1257. DOI: 10.1016/j.hpb.2019.12.002.
[11]	HIRAO H, NAKAMURA K, KUPIEC-WEGLINSKI JW. Liver ischaemia-reperfusion injury: a new understanding of the role of innate immunity[J]. Nat Rev Gastroenterol Hepatol, 2022, 19(4): 239-256. DOI: 10.1038/s41575-021-00549-8.
[12]	LIU JD, ZHANG LQ, SHI MZ, et al. Protective effects of modified limb remote ischemic preconditioning on myocardial injury in patients undergoing mitral valve replacement surgery[J]. Chin Circulation J, 2019, 34(3): 272-275. DOI: 10.3969/j.issn.1000-3614.2019.03.012. 刘金东, 张连芹, 石梦竹, 等. 改良肢体远端缺血预处理对二尖瓣置换术患者心肌损伤的保护作用[J]. 中国循环杂志, 2019, 34(3): 272-275. DOI: 10.3969/j.issn.1000-3614.2019.03.012.
[13]	GORJIPOUR F, SAEEDZADEH T, TOLOUEITABAR Y, et al. Remote ischemic preconditioning effects on inflammatory markers and myocardial protection in coronary artery bypass graft surgery[J]. Perfusion, 2022, 37(1): 56-61. DOI: 10.1177/0267659120979293.
[14]	XIA J, JIA R, QIAN YB, et al. Safety and efficacy of the controlled first hepaticportal blood flow occlusion in hepatectony[J]. Chin J Hepatobiliary Sury, 2021, 27(12): 889-893. DOI: 10.3760/cma.j.cn113884-20210429-00150. 夏俊, 贾冉, 钱叶本, 等. 控制性第一肝门阻断法在肝切除手术中的安全性和有效性[J]. 中华肝胆外科杂志, 2021, 27(12): 889-893. DOI: 10.3760/cma.j.cn113884-20210429-00150.
[15]	LIU XZ, LI MY, REN CN, et al. Specific measures to achieve controlled low central venous pressure during partial hepatectomy[J]. Chin J Hepatobiliary Surg, 2020, 26(6): 469-471. DOI: 10.3760/cma.j.cn113884-20200302-00106. 刘秀珍, 李明颖, 任超楠, 等. 大部肝切除术中实现控制性低中心静脉压的具体措施[J]. 中华肝胆外科杂志, 2020, 26(6): 469-471. DOI: 10.3760/cma.j.cn113884-20200302-00106.
[16]	LIU TS, SHEN QH, ZHOU XY, et al. Application of controlled low central venous pressure during hepatectomy: A systematic review and meta-analysis[J]. J Clin Anesth, 2021, 75: 110467. DOI: 10.1016/j.jclinane.2021.110467.
[17]	PAN YX, WANG JC, LU XY, et al. Intention to control low central venous pressure reduced blood loss during laparoscopic hepatectomy: A double-blind randomized clinical trial[J]. Surgery, 2020, 167(6): 933-941. DOI: 10.1016/j.surg.2020.02.004.
[18]	SHI XD, LI BB. Application of controlled low central venous pressure in hepatectomy[J]. J Clin Anesthesiol, 2021, 37(8): 871-874. DOI: 10.12089/jca.2021.08.019. 石雪朵, 李冰冰. 控制性低中心静脉压在肝脏切除术中的应用[J]. 临床麻醉学杂志, 2021, 37(8): 871-874. DOI: 10.12089/jca.2021.08.019.
[19]	LU JC. Application of dobutamine combined with nitroglycerin in ppartial hepatic resection under low central venous pressure[D]. Guangzhou: Guangzhou Medical University, 2020. 卢基成. 多巴酚丁胺联合硝酸甘油在控制性低中心静脉压下肝部分切除手术的应用[D]. 广州: 广州医科大学, 2020.
[20]	ZHANG H, ZHANG T, ZHONG F, et al. Effects of remote ischemic preconditioning on liver injury following hepatectomy: a systematic review and meta-analysis of randomized control trials[J]. Surg Today, 2021, 51(8): 1251-1260. DOI: 10.1007/s00595-020-02205-1.
[21]	WU J, YU C, ZENG X, et al. The hepatoprotective effect from ischemia-reperfusion injury of remote ischemic preconditioning in the liver related surgery: a meta-analysis[J]. ANZ J Surg, 2022, 92(6): 1332-1337. DOI: 10.1111/ans.17236.
[22]	MURRY CE, JENNINGS RB, REIMER KA. Preconditioning with ischemia: a delay of lethal cell injury in ischemic myocardium[J]. Circulation, 1986, 74(5): 1124-1136. DOI: 10.1161/01.cir.74.5.1124.
[23]	PRZYKLENK K, BAUER B, OVIZE M, et al. Regional ischemic 'preconditioning' protects remote virgin myocardium from subsequent sustained coronary occlusion[J]. Circulation, 1993, 87(3): 893-899. DOI: 10.1161/01.cir.87.3.893.
[24]	STANKIEWICZ R, GRT M. Direct, remote and combined ischemic conditioning in liver surgery[J]. World J Hepatol, 2021, 13(5): 533-542. DOI: 10.4254/wjh.v13.i5.533.
[25]	LIU A, FANG H. Ischemic preconditioning on liver ischemia reperfusion injury: How far is the bedside from the bench?[J]. J Invest Surg, 2020, 33(9): 884-885. DOI: 10.1080/08941939.2019.1578443.
[26]	JAKUBAUSKIENE L, JAKUBAUSKAS M, STIEGLER P, et al. Ischemic preconditioning for liver transplantation: A systematic review and meta-analysis of randomized controlled trials[J]. Visc Med, 2021, 37(5): 329-337. DOI: 10.1159/000516608.
[27]	KOH WU, KIM J, LEE J, et al. Remote ischemic preconditioning and diazoxide protect from hepatic ischemic reperfusion injury by inhibiting HMGB1-induced TLR4/MyD88/NF-κB signaling[J]. Int J Mol Sci, 2019, 20(23): 5899. DOI: 10.3390/ijms20235899.
[28]	JULIA S, PETER S, KARL-HEINZ W, et al. Possible role of the HMGB1 and RAGE inflammatory pathway in primary sclerosing cholangitis[J]. Clin Res Hepatol Gastroenterol, 2022, 46(2): 101791. DOI: 10.1016/j.clinre.2021.101791.
[29]	LIU JH, JIANG W, SHI G, et al. Effect of ischemic preconditioning on liver and kidney function in surgery for large vessels[J]. Chin J Gen Prac, 2019, 17(2): 190-192, 208. DOI: 10.16766/j.cnki.issn.1674-4152.000636. 刘建华, 蒋伟, 石光, 等. 大血管手术中应用缺血预处理对肝肾功能的影响[J]. 中华全科医学, 2019, 17(2): 190-192, 208. DOI: 10.16766/j.cnki.issn.1674-4152.000636.
[30]	SONG IA, JANG ES, OH TK. Validation of dynamic aspartate-to-alanine aminotransferase ratio for predicting liver disease mortality[J]. Hepatol Commun, 2022, 6(4): 740-749. DOI: 10.1002/hep4.1844.
[31]	KOBAYASHI D, YAMAMOTO K, KIMURA T, et al. Aspartate aminotransferase/alanine aminotransferase ratio and subsequent cancer development[J]. Cancer Med, 2022, 11(3): 798-814. DOI: 10.1002/cam4.4473.
[32]	LIU X, CAO L, ZHANG T, et al. Effect of remote ischemic preconditioning in patients undergoing hepatectomy with portal triad clamping: A randomized controlled trial[J]. Anesth Analg, 2019, 129(6): 1742-1748. DOI: 10.1213/ANE.0000000000004434.
[33]	OUYANG S, OUYANG L, LI Y, et al. Bone marrow-derived stem cells for patients with liver cirrhosis: A systematic review and meta-analysis[J]. Turk J Gastroenterol, 2021, 32(10): 896-906. DOI: 10.5152/tjg.2021.19694.

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Application of remote ischemic preconditioning combined with controlled low central venous pressure in hepatectomy

DOI: 10.3969/j.issn.1001-5256.2023.04.017

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Application of remote ischemic preconditioning combined with controlled low central venous pressure in hepatectomy

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