特利加压素对肝切除术后患者肝肾功能的影响

Effect of Terlipressin on Hepatic and Renal Function after Hepatectomy

目的探讨肝切除术后预防性使用特利加压素对患者肝肾功能的影响。方法将2009年10月至2011年10月期间武汉协和医院连续收治的肝储备功能差或肝切除范围大的原发性肝癌患者随机分为试验组和对照组,试验组(T组)48例,术后预防性使用特利加压素,对照组(C组)45例,未使用特利加压素,观察两组手术前后总胆红素(T-Bil)、丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)、尿素氮(BUN)、肌酐(Cr)含量变化。结果两组患者一般资料、肝功能分级、肝癌大小及合并癌栓情况、术中情况等具有可比性(均P>0.05)。术前两组各观察指标无明显差异(均P>0.05);T组患者的血AST、BUN、Cr水平于术后第4天、第7天均明显低于C组(均P<0.05),ALT、T-Bil水平于术后第7天明显低于C组(均P<0.05);T组未出现并发肝肾综合征病例,C组出现2例。结论术后预防性使用特利加压素对合并肝硬化的肝叶切除术患者的肝肾功能具有保护作用,并可减少术后肝肾综合征的发生。

Objective To investigate the effect of prophylactic terlipressin on hepatic and renal function after hepatectomy.Methods Consecutive hepatocellular carcinoma（HCC）patients who were admitted between Oct.2009 and Oct.2011were enrolled in the study.They had either impaired liver reserve function or major resection and were randomly divided into the experimental group（TG）（with prophylactic use of terlipressin after liver resection）and control group（CG）（without prophylactic use of terlipressin）.The baseline and postoperative levels of total bilirubin（T-Bil）,alanine aminotransferase（ALT）,aspartate aminotransferase（AST）,blood urea nitrogen（BUN）,serum creatinine（Cr）were observed in the two groups.Results There was no significant difference in general data,liver function,tumor stage,hepatic and renal function between the TG and CG groups（P 0.05）.The levels of blood AST,BUN and Cr in the TG group were significantly lower than those in the CG group on postoperative days（POD）4and 7（P0.05）,and the levels of blood ALT and T-Bil were significantly decreased in the TG group when compared with the CG group on POD 7（P0.05）.Two patients developed hepatorenal syndrome（HRS）in the CG group in contrast to none in the TG group.Conclusion The prophylactic use of terlipressin after hepatectomy has a protective effect on hepatic and renal function in patients with HCC and concomitant cirrhosis,and can decrease the incidence of HRS.