肝移植术后肝动脉缓冲效应及其临床意义的研究

Hepatic arterial buffer response and its clinical significance in liver transplantation

目的:分析肝移植术后早期血流变化规律,探讨肝动脉缓冲效应(hepatic arterial buffer response,HABR)与肝功能恢复及早期胆道并发症的关系。方法:应用B超仪检测肝移植术后1、2、3、7、14、21、28 d的肝动脉流量(HAF)和门静脉流量(PVF),选取40例有完整HABR(即HAF和PVF变化方向相反)的病人作为研究对象,运用HABR定量计算公式(BC=ΔHAF/ΔPVF),以中位数为界分为A、B两组(A组20例,BC<0.1037;B组20例,BC>0.1037),同时检测术后病人肝功能指标及早期胆道并发症发生情况。结果:A组术后的肝功能恢复天数显著长于B组(P<0.05);从具体指标上看,A组病人的天冬氨酸转氨酶分别在术后第7天、第2、4周显著低于B组(P<0.05),谷氨酸转氨酶分别在术后第2、4周显著低于B组(P<0.05),总胆红素分别在术后第2、3及4周显著低于B组(P<0.05),而A组术后早期胆道并发症发生率(25%)高于B组(15%),但P>0.05。结论:HABR在肝移植术中发挥着重要作用,可预示移植术后肝功能恢复的快慢,为早期诊断移植肝的功能障碍提供一定的指导。

Objective To study early hemodynamic curves after liver transplantation and the association of hepatic arterial buffer response（HABR） with liver function recovery and the early biliary complications（EBC）. Methods The hepatic artery flow and portal vein flow （preoperative and 1, 2, 3, 7, 14, 21, and 28 day postoperative） were monitored by duplex Doppler sonography in 40 patients subjected to liver transplantation. According to the different numerical values of BC （BC=AHAF/APVF）, 40 cases were divided into group A（BC〈0.1037, n=20） and group B （BC 〉0.1037, n=20）. Postoperative liver function tests and the incidence of EBC were determined. Results The recovery of liver functions in Group A was longer than that in Group B （P〈0.05）. However, the incidence of EBC in Group A （25%） and Group B （15%） did not differ between the groups （P〉0.05）. Conclusions HABF plays an important role in liver transplantation, which can indicate the time of liver function recovery .