三种不同人血白蛋白治疗方案在肝癌术后患者中的应用效果

Application effect of three different therapeutic schedules of human serum albumin in patients underwent operation for liver cancer

目的比较三种不同人血白蛋白治疗方案在肝癌术后患者中的运用效果。方法选择2013年2月~2015年4月在广东省中医院大学城医院行肝癌根治术117例术后患者,按照随机数字表将患者分为A、B、C三组,每组各39例。其中A组患者在术后直接使用5%的人血白蛋白注射液,B组直接使用20%的人血白蛋白注射液,C组患者在术后48 h内使用5%人血白蛋白注射液,48 h后使用浓度为20%的人血白蛋白注射液;分别收集三组患者在术后各时间段内的循环指标[尿量、中心静脉压（CVP）、平均动脉压（MAP）],胸腔引流指标（24 h引流量、组织间液量）,肝功能指标[丙氨酸转氨酶（ALT）、谷草转氨酶（AST）、总胆红素（STB）]。结果 A组与C组患者在术后48 h内尿量、CVP及MAP均明显高于B组（P〈0.05）,腹腔引流量较B组明显减少（P〈0.05）,各组间的肝功能差异无统计学意义（P〉0.05）;术后6 d时A组患者引流量明显高于B组和C组（P〈0.05）,术后6、10 d时C组患者ALT、AST和STB指标均明显低于A组和B组（P〈0.05）。结论通过在肝癌术后患者中合理分配等渗白蛋白及高渗白蛋白在纠正低蛋白血症的同时可有效改善液体平衡,减轻组织水肿,保持脏器的有效灌注,促进肝功能的恢复,提升白蛋白的利用率。

Objective To compare the application effect of three different therapeutic schedules of human serum albumin in patients underwent treatment for liver cancer. Methods From February 2013 to April 2015, in Guangdong Provincial Hospital of Traditional Chinese Medicine, 117 postoperative patients underwent radical operation for liver cancer were selected and divided into group A, group B and group C, with 39 cases in each group, according to random number table, patients in group A were treated directly with 5% human serum albumin injection, patients in group B were directly treated with 20% human serum albumin injection and those in group C were treated with 5% human serum albumin injection within 48 h ＋ 20% human serum albumin injection after 48 h; the cycle indicators（urine volume, CVP and MAP）, thoracic cavity drainage（drainage flow in 24 hours, interstitial fluid volume） and indexes regarding liver function（ALT, AST and STB） of three groups within each time period after operation were respectively collected. Results Within 48 h after operation, urine volume, CVP and MAP of patients in group A and group C were significantly higher than those in group B（P〈0.05）, the amount of thoracic cavity drainage in group A and group C were lower than that in group B（P〈0.05）, liver function of three groups were compared, the difference was not statistically significant（P〉0.05）. after operation 6 d, amount of thoracic cavity drainage in group A were higher than those in group B and group C（P〈0.05）, after operation 6, 10 d, ALT, AST and STB of patients in gorp C were lower than those in group A and group B（P〈0.05）. Conclusion In addition to correction of hypoalbuminemia, it can fluid balance effectively improved, reduce tissue edema, maintain effective perfusion of organs, promote recovery of liver function and increase utilization of albumin by rational distribution of isotonic and hypertonic albumin in patients undergoing operation for liver cancer.