不同门静脉淤血去除量对肝移植术后内毒素血症及肝功能恢复的影响

Effect of the amount of portal blood stasis removal on endotoxemia and liver function after liver transplantation

目的探讨肝移植术中不同门静脉淤血去除量对术后内毒素血症及肝功能恢复的影响。方法将2006年2月至2007年11月收治的47例肝移植患者按术中门静脉淤血去除量的不同分为两组：A组（n=26，门静脉淤血去除50ml）和B组（n=21，门静脉淤血去除200ml），检测受者手术前后血清内毒素、D-乳酸、肿瘤坏死因子-α、白细胞介素-6、肝功能及凝血功能的变化情况并进行分析比较。结果两组在性别、年龄、原发疾病类型、Child-pugh分级、供肝冷缺血时间、手术时间、无肝期时间、手术方式、出血量、输血量及术前各项检测指标无显著差异的条件下，B组术后血清内毒素、D-乳酸、肿瘤坏死因子-α、白细胞介素-6、谷氨酸转氨酶、天冬氨酸转氨酶、凝血酶原时间、部分凝血活酶时间均明显低于A组（P〈0．05）；前白蛋白明显高于A组（P〈0．05）。结论肝移植术中门静脉淤血去除200ml效果优于50ml，可以更好地减轻术后内毒血症，并有助于肝功能的恢复。

Objective To investigate the inflence of the amount of portal blood stasis removal on endotoxemia and liver function after liver transplantation. Methods Forty-seven patients who received liver transplantation from February 2006 to November 2007 were divided into 2 groups according to the amount of portal blood stasis removal during operation ： group A （ n = 26） 50 ml and group B （ n = 21 ） 200 ml of portal blood stasis removal respectively. The levels of plasma endotoxin, D-lactate, tumor necrosis factor-α, interleukin-6, liver function and blood coagulation were examined and analyzed. Results Under the condition of no significant difference in sex, age, primary liver diseases and Child-pugh＇s classification, cold ischemic time, total operation and anhepatic time, operation methods, volume of blood loss and transfusion, and all preoperative observations. Most of observations showed the restoration of the patients in group B was better than that in group A. The plasma levels of endotoxin, D-lactate,tumor necrosis factor-α, interleukin-6, alanine aminotransferase, aspartate aminotransferase, prothrombin time and activated partial thromboplastin time in group B were significantly lower than those in group A （P 〈 0. 05 ）. The level of plasma prealbumin in group B was significantly higher than that in group A （ P 〈 0. 05 ）. Condusions The removal of 200 ml portal blood stasis leads to a better results than that of 50 ml, and it can help alleviate endotoxemia and facilitate the restoration of the liver function after liver transplantation.