肝癌合并乙肝肝硬化患者术后应用特利加压素效果分析

发布时间：2018-04-04 01:16

本文选题：特利加压素　切入点：肝癌合并乙肝肝硬化　出处：《山东大学》2017年硕士论文

【摘要】：目的:本研究旨在讨论对肝癌合并乙肝肝硬化患者(术后病理证实)行肝癌切除术后应用特利加压素疗效效果,从而寻找加速肝癌合并乙肝肝硬化患者术后恢复、减少术后并发症的方法。资料与方法:本研究选取山东省立医院器官移植肝胆外二科2016.05-2016.12收治的100例肝癌合并乙肝肝硬化患者,使用随机表法随机分为实验组及对照组。两组患者的性别、年龄、术前血红蛋白、凝血酶原时间、总胆红素、手术时间、术中出血量及肝门阻断时间均无明显统计学差异。实验组(特利加压素组)于术后当天开始,常规预防性使用特利加压素2mg/d,使用0.9%氯化钠溶液40ml溶解,24小时持续泵入,应用最长时间不超过12d;对照组(非特利加压素组)采用传统的利尿剂(螺内酯、呋塞米)、多巴胺治疗。分别于术后第一、第三及第五天空腹时静脉采血测定两组患者的总胆红素(T-bil)、丙氨酸氨基转移酶、天冬氨酸氨基转移酶、肌酐、尿素氮,同时记录两组患者腹腔引流管拔管时间、胸腔积液发生数及出院时间,并使用SAS软件分析两组差异,从而对术后应用特利加压素的效果进行评价分析。结果:两组患者术后第一天实验组总胆红素、丙氨酸氨基转移酶、天冬氨酸氨基转移酶、肌酐、尿素氮水平为别为30.8023±3.06435 umol/L、370.51 ±43.762 U/L、482.14±48.126U/L、65.240±3.4698umol/L.6.24±0.399mmol/L;对照组总胆红素、丙氨酸氨基转移酶、天冬氨酸氨基转移酶、肌酐、尿素氮水平为别为36.8396±5.41013umol/L、433.54±55.070U/L、483.22±54.129U/L、66.190±3.2626umol/L、6.35±0.394mmol/L,两组之间各指标无显著性差异(P0.05)。术后第三天实验组总胆红素(T-bil)、丙氨酸氨基转移酶、天冬氨酸氨基转移酶、肌酐、尿素氮水平分别为39.523±3.4553umol/L、97.66±15.5U/L、205.30±28.317U/L、61.94±2.855umol/L、6.933±0.4423 mmol/L,对照组总胆红素、丙氨酸氨基转移酶、天冬氨酸氨基转移酶、肌酐、尿素氮水平为别为54.207±5.7861umol/L、150.16±21.4U/L、261.84±43.882U/L、71.25±3.350umol/L、7.430±0.3138mmol/L,两组各个数据之间存在统计学差异(P= 0.0027,0.0439,0.0454,0.0366,0.0365);术后第五天实验组总胆红素、丙氨酸氨基转移酶、天冬氨酸氨基转移酶、肌酐、尿素氮水平分别为33.284±4.0263umol/L、59.00±8.827U/L、86.73± 12.702U/L、62.23±2.084umol/L、5.943±0.3276 mmol/L,对照组总胆红素、丙氨酸氨基转移酶、天冬氨酸氨基转移酶、肌酐、尿素氮水平为别为54.963±6.8413umol/L、69.47±6.225U/L、122.17±24.010U/L、69.52±3.747umol/L、7.186±0.4525mmol/L,两组各个数据之间存在统计学差异(P=0.0001,0.0002,0.0210,0.0196,0.0317)。实验组腹腔引流管拔管时间(7.31 ±0.554天)明显少于实验组拔管时间(8.25±0.667天)(p=0.034);实验组胸腔积液发生例数(1例)明显少于对照组患者胸腔积液发生例数(7例)(p=0.045);实验组住院天数(10.03±0.256 天)少于对照组(11.23±0.335 天)(p=0.041)。结论:本研究显示特利加压素的应用能够改善肝癌合并乙肝肝硬化患者术后的肝肾功能,缩短术后腹腔引流管拔管天数,减少胸腔积液的发生率、缩短住院天数。提示肝癌合并乙肝肝硬化患者行肝癌切除术后应用特利加压素可以减少其并发症的发生,同时加速其恢复。
[Abstract]:Objective: the purpose of this study is to discuss the hepatocellular carcinoma patients with liver cirrhosis (thepostoperativepathology) curative effect of vasopressin for application. After resection of hepatocellular carcinoma, in order to find the acceleration of HCC patients with liver cirrhosis after recovery, reduce the postoperative complications. Materials and methods: This study selected two Department of hepatobiliary surgery Shangdong Province-owned Hospital organ transplant 2016.05-2016.12 a total of 100 cases of hepatocellular carcinoma complicated with liver cirrhosis patients, using randomly divided into experimental group and control group. Two groups of patients with gender, age, preoperative hemoglobin, total bilirubin, prothrombin time, operation time, intraoperative blood loss and hepatic portal occlusion time has no significant difference between the experimental group (terlipressin. In group A) on postoperative day, routine prophylactic use of terlipressin in 2mg/d, using Sodium Chloride Solution 40ml 0.9% dissolved, 24 hours continuous pumping, the longest time the application No more than 12D; the control group (non terlipressin group) using conventional diuretics (spironolactone and furosemide), dopamine treatment. After operation respectively the first, third and five of the sky when the abdominal venous blood determination of total bilirubin in the patients of the two groups (T-bil), alanine aminotransferase, aspartate aminotransferase at the same time, creatinine, urea nitrogen, records of two patients of abdominal drainage tube extubation time, pleural effusion and the number of discharge time, and analyze the differences between the two groups using the SAS software, so as to evaluate the effect of vasopressin application after operation. Results:. Two groups of patients after the first day of the experimental group total bilirubin, alanine aminotransferase, aspartate aminotransferase, creatinine, urea nitrogen level was 30.8023 + 3.06435 umol/L 370.51 + 43.762 U/L, 482.14 + 48.126U/L, 65.240 + 3.4698umol/L.6.24 + 0.399mmol/L; control group, total bilirubin, alanine Y-ggt, aspartate aminotransferase, creatinine, urea nitrogen respectively was 36.8396 + 5.41013umol/L, 433.54 + 55.070U/L, 483.22 + 54.129U/L, 66.190 + 3.2626umol/L, 6.35 + 0.394mmol/L, there was no significant difference between the two groups of each index (P0.05). After third days the experimental group total bilirubin (T-bil). Alanine aminotransferase, aspartate aminotransferase, creatinine, urea nitrogen levels were 39.523 + 3.4553umol/L, 97.66 + 15.5U/L, 205.30 + 28.317U/L, 61.94 + 2.855umol/L, 6.933 + 0.4423 mmol/L, control group, total bilirubin, alanine aminotransferase, aspartate aminotransferase, creatinine, urea nitrogen level to do was 54.207 + 5.7861umol/L, 150.16 + 21.4U/L, 261.84 + 43.882U/L, 71.25 + 3.350umol/L, 7.430 + 0.3138mmol/L, there were significant differences between the two groups (P= 0.0027,0.0439,0.0454,0.0366,0.0365); all data after fifth days of experimental group Total bilirubin, alanine aminotransferase, aspartate aminotransferase, creatinine, urea nitrogen levels were 33.284 + 4.0263umol/L, 59 + 8.827U/L, 86.73 + 12.702U/L, 62.23 + 2.084umol/L, 5.943 + 0.3276 mmol/L, control group, total bilirubin, alanine aminotransferase, aspartate aminotransferase, creatinine, urea nitrogen the level is not as 54.963 + 6.8413umol/L, 69.47 + 6.225U/L, 122.17 + 24.010U/L, 69.52 + 3.747umol/L, 7.186 + 0.4525mmol/L, there were significant differences between the two groups (P= 0.0001,0.0002,0.0210,0.0196,0.0317). The data of the experimental group of abdominal drainage tube extubation time (7.31 + 0.554 days) was significantly less than the experimental group extubation time (8.25 + 0.667 days) the experimental group (p=0.034); the incidence of pleural effusion (1 cases) was significantly less than the control group of patients with pleural effusion cases (7 cases) (p=0.045); the experimental group hospitalization time (10.03 + (0.256 days) than in the control group 11.23 + 0.335 days) (p=0.041). Conclusions: This study shows that terlipressin application can improve kidney function in patients with hepatocellular carcinoma after liver cirrhosis, shorten the extubation time of abdominal drainage after operation, reduce the incidence of pleural effusion, shorten the hospitalization days. Tips for liver cancer patients after resection of hepatocellular carcinoma with hepatitis B cirrhosis terlipressin can reduce the incidence of complications, and to accelerate its recovery.

【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R735.7;R512.62;R575.2

【相似文献】