胆碱酯酶对肝切除术肝脏储备功能的评估作用及意义

发布时间：2018-03-03 13:57

本文选题：肝储备功能　切入点：肝切除　出处：《宁夏医科大学》2015年硕士论文　论文类型：学位论文

【摘要】：目的观察并研究胆碱酯酶(Cholinesterase,CHE)在不同肝脏组织中与凝血酶原时间(Prothrombin time,PT)、白蛋白(Albumin,ALB)、胆红素(Bilirubin,BIL)等评价肝脏储备功能指标间的关系,并分析肝切除各项手术因素对于CHE的影响,以此评价CHE对肝切除术病例肝脏储备功能的评估作用及意义,为建立肝切除术术前肝储备功能新型评估系统提供临床依据。方法:1.回顾性观察2010年-2013年在宁夏医科大学总医院肝胆外科行肝脏切除术的病例、在宁夏医科大学总医院感染疾病科因肝硬化住院治疗的病例、以及健康体检者的CHE、ALB、PT、BIL的差异,分析CHE在Child分级之间的关系。2.测定2014年4月-2015年3月在我科行肝切除的原发性肝癌、肝血管瘤患者围手术期的CHE、血清白蛋白、凝血酶原时间、胆红素水平及术中失血量、肝门阻断时间、手术时间及标准残肝率(标准残肝率=术后肝体积/术前肝体积),分析CHE与上述指标之间的相关性。通过单因素分析和Pearson相关分析确定CHE对肝切除术肝功能储备功能的评估作用。结果:在Child分级中,胆碱酯酶水平在各组间差异具有统计学意义(P0.05);胆碱酯酶与血清白蛋白、凝血酶原时间的相关性各组间均具有统计学意义(P0.05),胆碱酯酶与胆红素相关性在Child C级中具有统计学意义(P0.05)。胆碱酯酶水平在肝切除术前、后变化差异具有统计学意义,与Child分级研究术后差异具有统计学意义(P0.05);胆碱酯酶变化率与手术时间、术中出血量、肝门阻断时间的相关性研究均无统计学意义(P0.05),胆碱酯酶变化率与残肝率呈正相关(r=0.487,P=0.029)。结论:血清胆碱酯酶水平变化与肝脏功能受损状况具有一致性。胆碱酯酶变化率与残肝率有着紧密的联系,肝储备功能受肝切除外影响因素较小,胆碱酯酶在一定程度上可反应肝储备功能的变化。
[Abstract]:Objective to investigate the relationship between cholinesterase Cholinesterase (che) and prothrombin time prothrombin time (prothrombin time), albumin albumin Albumin (ALBN), bilirubin bilirubin (bilirubin bilirubin bilirubin CHE) in different liver tissues, and to analyze the effect of various surgical factors on CHE. To evaluate the role and significance of CHE in evaluating hepatic reserve function in patients undergoing hepatectomy. To provide the clinical basis for establishing a new evaluation system of liver reserve function before hepatectomy methods: 1. Retrospective observation was made on the cases of hepatectomy performed in the Department of Hepatobiliary surgery, General Hospital of Ningxia Medical University from 2010 to 2013. The relationship between CHE and Child grade was analyzed in patients with liver cirrhosis hospitalized in Department of General Hospital infection, Ningxia Medical University, and in healthy persons. The relationship between CHE and Child grade was analyzed. The hepatectomy of primary liver cancer was performed in our department from April 2014 to March 2015. Perioperative CHE, serum albumin, prothrombin time, bilirubin level, intraoperative blood loss, hepatic portal occlusion time in patients with hepatic hemangioma. The operative time and the standard liver remnant rate (standard liver remnant rate = postoperative liver volume / preoperative liver volume) were analyzed. The correlation between CHE and the above indexes was analyzed. The liver function reserve of CHE for hepatectomy was determined by univariate analysis and Pearson correlation analysis. Function evaluation. Results: in the Child classification, The levels of cholinesterase were significantly different among the groups (P 0.05), and the levels of cholinesterase and serum albumin, The correlation between prothrombin time and cholinesterase and bilirubin was statistically significant in all groups. The level of cholinesterase was significantly different before and after hepatectomy in Child C grade. There was a significant difference between the study of cholinesterase and Child, the change rate of cholinesterase, the time of operation and the amount of blood lost during operation. There was no significant correlation between hepatic portal occlusion time and cholinesterase activity. There was a positive correlation between cholinesterase level and residual liver rate. Conclusion: the change of serum cholinesterase level is consistent with liver function damage. There is a close relationship between the rate of liver remnant and the rate of residual liver. The liver reserve function was less affected by hepatectomy, and cholinesterase could reflect the change of liver reserve function to some extent.
【学位授予单位】：宁夏医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R657.3

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