不同程度肝硬化患者肝移植围术期血浆内毒素的变化

The perioperative variations of plasma endotoxin in patients with different degrees of liver cirrhosis during liver transplantation

目的观察不同程度肝硬化患者肝移植手术围术期血浆内毒素的变化。方法择期肝移植手术患者48例,依据肝硬化程度,按照Child-Pugh分级分为A组(A级),B组(B级)和C组(C级),每组16例。采用鲎试验基质偶氮显色法检测无肝前期第一肝门游离完毕(T1)、无肝期门静脉开始吻合(T3)、新肝期肝动脉开放后15min(T5)和术后24h(T7)血浆内毒素水平。结果与T1时比较,T5时A、B组,T3、T5时C组血浆内毒素水平明显升高,而T7时B、C组血浆内毒素水平明显降低(P<0.05)。与T3时比较,T5时A、B组血浆内毒素水平明显升高,而T7时C组明显降低(P<0.05)。与T5时比较,T7时B、C组血浆内毒素水平明显降低(P<0.05)。T1时B、C组血浆内毒素水平明显高于A组,且C组明显高于B组(P<0.05)。结论不同程度肝硬化患者肝移植围术期血浆内毒素水平变化存在明显差异。

Objective To investigate the perioperative variations of plasma endotoxin in patients with different degrees of liver cirrhosis during liver transplantation. Methods Forty-eight patients scheduled elective liver transplantation were divided into 3 groups according to the Child-Pugh score： group A（class A, 16 patients）, group B（class B, 16 patients）, and group C（class C, 16 patients）. The inclusion criteria were liver cirrhosis, for the first time to accept liver transplantation, without acute liver failure, and exclusion of acceptect ar＊;qcial liver support system before operation To measure the concentration of plasma endotoxin in pre-anhepatic phase （T1）, anhepatic phase （Ta）, neohepatic phase （Ta）, and 24 hours after surgery（T7 ）. Results At TI, the level of plasma endotoxin of the groups increased with Child-Pugh scores raised. At T3, group C had significantly changed in comparison with T1. At T5, group A and B had significantly increased in comparison with Ta. At T7, all groups had significantly decreased comparison with T5. Conclusion The perioperative variations of plasma endotoxin are different in the patients with different degrees of liver cirrhosis.