肝脏手术后病人白蛋白临床应用研究

Clinical application of albumin administration in patients following liver surgery

目的 总结和探讨不同肝脏疾病行不同范围肝切除手术后病人白蛋白的应用情况和疗效.方法 收集北京协和医院2005年6月至2007年3月收治的132例肝切除手术病人的临床资料,根据肝功能和切除范围分为肝血管瘤组、肝癌1组和肝癌2组,就术后补充白蛋白情况及其对手术预后的影响进行统计分析.结果 在术前肝功能正常的血管瘤组,补充白蛋白对术后病人血清白蛋白变化[（3.17±0.40）g/L vs（3.15±0.23）g/L,P=0.37]和其他肝功能指标改变无效果;在肝功能Child-Pugh A级、行2～3肝段切除肝癌病人中,术后补充白蛋白也未起到明确的效果[（3.17±0.40）g/L vs（3.15±0.23）g/L,P=0.37];而对术前肝功能异常和（或）行半肝或以上肝切除病人,常规进行白蛋白的补充维持了较低的并发症发生率.结论 对于术前肝功能正常的行中小肝脏手术的病人,可以缩小术后补充白蛋白指征;而对于术前有明确低白蛋白血症者,则提议在围手术期补充白蛋白,这可能对减少并发症、改善手术预后有益.

Objective To summarize and discuss the result and effectiveness of postoperative administration of albumin in patients with different liver diseases performed various hepatectomy. Methods The clinical data of 132 patients performed hepatectomy between June 2005 and March 2007 in Peking Union Medical College Hospital were analyzed. All the patients were divided into three groups according to the types of the surgery and function of the liver：hepatic hemangioma group,liver cancer groupl ,and liver cancer group 2. The supplementation of albumin and its influence on postoperative liver function and recovery were analyzed. Results The administration of albumin had no significant effect on postoperative serum albumin levels （3.17 ± 0.40 vs 3.15 ± 0.23, P = 0. 37 ） and other liver functions in the hepatic bemangioma group with normal liver function;The application of albumin had also no effect on post-operative serum albumin levels （ 3.17 ±0.40 vs 3.15 ± 0. 23, P = 0. 37 ） in the cancer group with Child A liver function, following 2 - 3 hepatic segments excision;Whereas to those who had hypoalbuminemia preoperatively and/or underdone lobectomy or up, supplementation of albumin routinely postoperation had an effect of maintain lower incidence of complications. Conclusion The indication of postoperative use of albumin can be restrictive in the patients with normal liver function and performed smallmedium liver resection. However,administration of albumin is suggested in the patients with preoperative significant hypoalbuminemia and/or performed major hepatectomy. It may decrease the incidence of complications and improve the prognosis of the surgery.