短期禁食预处理对肝脏部分切除术后缺血再灌注损伤保护作用的临床研究

发布时间：2018-10-24 18:57

【摘要】：目的:对拟通过肝血流阻断切除肿瘤的患者预先给予短期(24 h)禁食预处理,观察其对术后发生的肝脏缺血/再灌注(ischemia reperfusion,I/R)损伤的保护作用。方法:采用前瞻性随机对照研究,收集2015年10月至2016年5月南京医科大学第一附属医院收治的肝功能Child-Pugh分级均为A级、拟行肝脏部分切除术的80例患者,按随机数余数法分为实验组(术前禁食24 h、禁饮8 h)和对照组(常规术前禁食、禁饮),再将两组患者按肿瘤直径及阻断时间分组,于术前和术后(1、3、7 d)测定血清丙氨酸转氨酶(ALT)、天门冬氨酸转氨酶(AST)、总胆红素(TBil)、直接胆红素(DBil)、总蛋白、白蛋白(ALB)水平。结果:术后两组患者ALT、AST、TBil、DBil明显升高,实验组患者术后1、3、7 d血清ALT水平明显低于对照组,有统计学差异(P0.05),实验组患者术后1、3 d的TBil、DBil均不同程度的低于对照组(P0.05)。两组患者术后3、7 d总蛋白及白蛋白无明显统计学差异(P0.05)。两组患者术后并发症发生率无明显统计学差异(P0.05)。无论肿瘤直径是否5 cm,无论阻断时间是否20 min,实验组术后(1、3 d)ALT水平都较对照组降低(P0.05)。结论:入肝血流阻断肝部分切除术可造成一定程度的肝脏缺血再灌注损伤;短期禁食可能通过抑制肝脏缺血再灌注损伤后炎症因子的释放、增加抗炎因子产生、增加自噬效应,减轻肝组织损伤,从而保护肝脏缺血再灌注损伤。
[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.
【作者单位】：南京医科大学第一附属医院肝脏外科/肝脏移植中心国家卫生和计划生育委员会活体肝移植重点实验室;
【基金】：国家自然科学基金项目面上项目(81273262)
【分类号】：R657.3

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