發(fā)布時(shí)間：2018-10-24 18:57

【摘要】：目的:對(duì)擬通過(guò)肝血流阻斷切除腫瘤的患者預(yù)先給予短期(24 h)禁食預(yù)處理,觀察其對(duì)術(shù)后發(fā)生的肝臟缺血/再灌注(ischemia reperfusion,I/R)損傷的保護(hù)作用。方法:采用前瞻性隨機(jī)對(duì)照研究,收集2015年10月至2016年5月南京醫(yī)科大學(xué)第一附屬醫(yī)院收治的肝功能Child-Pugh分級(jí)均為A級(jí)、擬行肝臟部分切除術(shù)的80例患者,按隨機(jī)數(shù)余數(shù)法分為實(shí)驗(yàn)組(術(shù)前禁食24 h、禁飲8 h)和對(duì)照組(常規(guī)術(shù)前禁食、禁飲),再將兩組患者按腫瘤直徑及阻斷時(shí)間分組,于術(shù)前和術(shù)后(1、3、7 d)測(cè)定血清丙氨酸轉(zhuǎn)氨酶(ALT)、天門冬氨酸轉(zhuǎn)氨酶(AST)、總膽紅素(TBil)、直接膽紅素(DBil)、總蛋白、白蛋白(ALB)水平。結(jié)果:術(shù)后兩組患者ALT、AST、TBil、DBil明顯升高,實(shí)驗(yàn)組患者術(shù)后1、3、7 d血清ALT水平明顯低于對(duì)照組,有統(tǒng)計(jì)學(xué)差異(P0.05),實(shí)驗(yàn)組患者術(shù)后1、3 d的TBil、DBil均不同程度的低于對(duì)照組(P0.05)。兩組患者術(shù)后3、7 d總蛋白及白蛋白無(wú)明顯統(tǒng)計(jì)學(xué)差異(P0.05)。兩組患者術(shù)后并發(fā)癥發(fā)生率無(wú)明顯統(tǒng)計(jì)學(xué)差異(P0.05)。無(wú)論腫瘤直徑是否5 cm,無(wú)論阻斷時(shí)間是否20 min,實(shí)驗(yàn)組術(shù)后(1、3 d)ALT水平都較對(duì)照組降低(P0.05)。結(jié)論:入肝血流阻斷肝部分切除術(shù)可造成一定程度的肝臟缺血再灌注損傷;短期禁食可能通過(guò)抑制肝臟缺血再灌注損傷后炎癥因子的釋放、增加抗炎因子產(chǎn)生、增加自噬效應(yīng),減輕肝組織損傷,從而保護(hù)肝臟缺血再灌注損傷。
[Abstract]:Aim: to observe the protective effect of short-term (24 h) fasting preconditioning on hepatic ischemia / reperfusion (ischemia reperfusion,I/R) injury in patients undergoing hepatic blood flow occlusion. Methods: a prospective randomized controlled study was conducted in 80 patients with liver function Child-Pugh grade A who were admitted to the first affiliated Hospital of Nanjing Medical University from October 2015 to May 2016. According to the method of random remainder, the patients were divided into two groups: experimental group (fasting 24 hours before operation, no drinking for 8 hours) and control group (routine fasting before operation, no drinking). The two groups were divided into two groups according to tumor diameter and blocking time. Serum alanine aminotransferase (ALT), aspartate transaminase (AST), total bilirubin (TBil), direct bilirubin (DBil), total protein and albumin (ALB) were measured before and 7 days after operation. Results: ALT,AST,TBil,DBil was significantly increased in the two groups. The serum ALT level in the experimental group was significantly lower than that in the control group on the 7th day after operation (P0.05). The TBil,DBil of the experimental group was lower than that of the control group in different degree on the 3rd day after operation (P0.05). There was no significant difference in total protein and albumin between the two groups 3 days after operation (P0.05). There was no significant difference in the incidence of postoperative complications between the two groups (P0.05). No matter whether the tumor diameter was 5 cm, or not, the level of 3 d) ALT in the experimental group was lower than that in the control group (P0.05). Conclusion: partial hepatectomy can induce liver ischemia reperfusion injury, and short term fasting may increase anti-inflammatory factor production and autophagy effect by inhibiting the release of inflammatory factors after hepatic ischemia reperfusion injury. To reduce liver tissue injury and protect liver from ischemia reperfusion injury.
【作者單位】： 南京醫(yī)科大學(xué)第一附屬醫(yī)院肝臟外科/肝臟移植中心國(guó)家衛(wèi)生和計(jì)劃生育委員會(huì)活體肝移植重點(diǎn)實(shí)驗(yàn)室;
【基金】：國(guó)家自然科學(xué)基金項(xiàng)目面上項(xiàng)目(81273262)
【分類號(hào)】：R657.3

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