动脉血酮体比率测定对预测肝癌手术风险的临床价值

Study in Values of AKBR as an indicator of postoperative risk in patient with PHCC

本文测定３２例原发性肝癌病人术前及术后第１、３、５、７天的动脉血酮体比率（ＡＫＢＲ）、凝血酶原时间（ＰＴ）、谷丙转氨酶（ＳＧＰＴ）和胆红素（ＳＢ）（包括直接胆红素（ＤＳＢ）和总胆红素（ＴＳＢ），并以７例慢性结石性胆囊炎病人作为对照。结果：①术前ＡＫ－ＢＲ≥０．７者，肝脏储备功能佳，能耐受各类肝切除术，术后并发症发生率少；ＡＫＢＲ≤０．４，肝脏储备功能极差，无法耐受任何方式的肝脏手术，死亡率高。②ＡＫＢＲ的值存在一个关键性临界范围０．２５～０．４，在术后１～５天内ＡＫＢＲ值若持续停滞在这个区域，说明肝脏能量代谢极度低下，术后死亡率为１００％。③ＡＫＢＲ与ＰＴ（活动度）、ＤＳＢ和ＴＳＢ存在一定的相关性，相关系数分别为０．５６８、－０．４３３和－０．４７８，Ｐ值均＜０．００１。以上结果表明临床现行的肝功能试验对评价肝功能的意义较小，难以确切地反映肝脏潜在的储备功能及预测手术风险。而ＡＫ－ＢＲ能准确地反映术前肝脏储备功能及其对手术的耐受性，能为评价手术风险性及指导围手术期的治疗提供可靠的依据。

The study measured AKBR. PT. SGPT. DSB and TSB at preoperative and postoperative 1 st. 、3rd、5th and 7th day in 32 cases with primary hepatic cellular carcinoma and 7 cases with chroic cholecystitis. The results showed:① When AKBR≥0. 7,the patients tolerated their operations well and no any death, when 0. 4<AKBR<0. 7,the patients had concomitanted with more complications such as pleural effusion and heppatic failure etc. And AKBR≤0. 4, the patients coudn't tolerated their operations. and died from hepatic failure or multiple organ failure. ② AKBR had the critical zone 0. 25～0. 4. The longer the duration in critical zone, the poorer the chances of recovery. The patients whose AKBR remained in critical zone Longer than 5 days had virtually no chance of recovery and died of hepatic failure or MOF. ③ AKBR was positively correlated with PT r=0. 568 P<0. 001 ④ AKBR was negatively correlated with DSB and TSB r=-0. 433 and r=-0. 478. P<0. 001. The study stated that AKBR reflects hepatic mitochondrial redox potential. It was the clinic significance in that AKBR can value postoperative rish and guide to treat patients during perioperative period