原发性肝癌合并肝硬化患者肝切除术后人血白蛋白的应用分析

Usage analysis of human serum albumin in patients with liver cancer and liver cirrhosis after hepatectomy

目的分析肝癌合并肝硬化患者术后人血白蛋白的用法。方法将2012年1月-2014年1月收治的121例肝癌合并肝硬化接受肝切除术患者分为对照组60例和观察组61例,两组患者在常规保肝等内科治疗基础上加用人血白蛋白制剂。观察组:术后48 h内予5%人血白蛋白静脉滴注,48 h复查患者血浆白蛋白水平,若白蛋白<35 g/L,予20%的人血白蛋白直至患者白蛋白≥35 g/L。对照组:术后48 h内即予20%人血白蛋白静脉滴注至白蛋白≥35 g/L。观察两组患者血白蛋白使用量、血浆用量,术后第1、3、7、10天的尿量、腹腔引流量、中心静脉压(CVP)、平均动脉压(MAP)、血栓弹力图(TEG)R值与K值变化情况,术前及术后肝功能指标变化情况及第7天吲哚靛青绿15 min储留率(ICGR15)变化情况。计量资料两组间比较采用独立样本t检验,计数资料采用χ2检验。结果两组患者在年龄、性别、Child-Pugh分级、手术方式、术中出血量、第一肝门阻断时间、手术时间比较差异无统计学意义(P值均>0.05),而人血白蛋白用量、血浆用量、住院时间构成差异有统计学意义(P值均<0.05)。术后第1天及第3天,两组每日尿量、CVP、MAP、腹腔引流量、组织间液量差异有统计学意义(P值均<0.05),而到第7天两组上述指标差异无统计学意义(P值均>0.05)。术后第1天及第3天ALT、AST、TBil及TEG的R值与K值两组比较差异均无统计学意义(P值均>0.05),直到第7天开始两组上述指标的差异才具有统计学意义(P值均<0.05)。术后第7天,观察组ICGR15为(16.59±4.40)%,对照组为(13.21±4.20)%,两组比较差异有统计学意义(t=5.23,P=0.000)。结论术后等渗白蛋白和高渗白蛋白的分时段运用较单纯使用高渗白蛋白更能够发挥临床效能。

Objective To analyze the usage of human serum albumin in patients with liver cancer and liver cirrhosis after hepatectomy.Methods A total of 121 patients with liver cancer and liver cirrhosis who received hepatectomy in our hospital from January 2012 to January2014 were divided into control group（ n = 60） and observation group（ n = 61）. Both groups received human serum albumin in addition to the routine treatment for liver protection. The observation group was given intravenous drip of 5% human serum albumin within 48 h after surgery. The plasma albumin concentrations of patients were measured at 48 h after surgery,and if the concentration was 35 g / L,the patients would be given 20% human serum albumin until the concentration was ≥35 g / L. The control group was given intravenous drip of 20%human serum albumin within 48 h after surgery until the plasma albumin concentration was ≥35 g / L. The amounts of used human serum albumin and plasma were recorded for both groups. The urine volume,abdominal drainage volume,central venous pressure（ CVP）,mean arterial pressure（ MAP）,and thromboelastogram（ TEG） R and K values were measured at 1,3,7,and 10 days after surgery. The liver function indices before and after surgery and the indocyanine green retention rate at 15 minutes（ ICG R15） at 7 days after surgery were measured. Comparison of continuous data between the two groups was made by t test,while comparison of categorical data was made by chisquare test. Results（ 1） There were no significant differences in age,sex,Child- Pugh classification,surgical approach,intraoperative blood loss,occlusion time of the first porta hepatis,and operation time between the two groups（ P〈0. 05）. But there were significant differences in the amounts of used human serum albumin and plasma and the length of hospital stay between the two groups（ P〈0. 05）.（ 2） There were significant differences in daily urine volume,CVP,MAP,abdominal drainage volume,and interstitial fluid volume at 1 and 3 days after surgery between the two groups（ P〈0. 05）,but there were no significant differences in the above indices at 7 days after surgery between the two groups（ P〈0. 05）. There were no significant differences in alanine aminotransferase,aspartate aminotransferase,total bilirubin,and TEG R and K values at 1 and 3 days after surgery between the two groups（ P〈0. 05）,but significant differences were observed in the above indices at 7 days after surgery（ P〈0. 05）.（ 3） There was a significant difference in ICGR15 at 7 days after surgery between the observation group and the control group（ 16. 59% ± 4. 4% vs 13. 21% ± 4. 2%,t = 5. 23,P = 0. 000）. Conclusion The isotonic albumin and hypertonic albumin used in different periods after surgery have a better clinical effect than hypertonic albumin alone.