围手术期应用地塞米松对原发性肝癌患者肝切除术后肝功能的影响分析

Inhibition of inflammatory reaction by intravenous administration of dexamethasone after hepatectomy in patients with primary liver cancer

目的观察围手术期应用地塞米松对肝切除手术患者术后肝功能的影响。方法选择行肝切除手术的原发性肝癌患者160例,随机分为观察组80例和对照组80例。给予对照组患者常规药物治疗,术后给予观察组患者地塞米松治疗3 d,记录并分析术前和术后不同时间两组患者谷丙转氨酶(ALT)、谷草转氨酶(AST)、白蛋白(ALB)、总胆红素(TBIL)、炎症因子超敏C-反应蛋白(hs-CRP)、白细胞介素-8(IL-8)变化和术后并发症发生情况。结果观察组术后第3天和第7天血清ALT水平分别为(114.6±14.9)U/L和(50.2±6.7)U/L,均显著低于对照组【(279.2±21.2)U/L和(79.8±11.0)U/L,差异均有显著性(P<0.05);观察组术后第3天和第7天血清AST水平分别为(141.2±16.0)U/L和(59.8±7.1)U/L,均显著低于对照组【(299.3±20.4)U/L和(85.5±12.4)U/L,P<0.05);血清ALB水平分别为(34.8±1.6)g/L和(38.3±1.9)g/L,均显著高于对照组【(31.6±1.4)g/L和(35.0±1.8)g/L,P<0.05);血清TBIL水平分别为(32.2±2.7)μmol/L和(27.1±2.4)μmol/L,均显著低于对照组【(36.2±3.1)μmol/L和(31.2±2.6)μmol/L,P<0.05);观察组术后第1天和第7天血清hs-CRP水平分别为(25.0±3.1)mg/L和(17.8±2.1)mg/L,均显著低于对照组【(30.6±3.8)mg/L和(21.0±2.6)mg/L,P<0.05);血清IL-8水平分别为(24.0±3.0)pg/ml和(14.0±1.9)pg/ml,均显著低于对照组【(28.6±3.7)pg/ml和(18.5±2.1)pg/ml,P<0.05);术后两组并发症发生率为35.0%和23.8%,差异无统计学意义(P>0.05)。结论地塞米松可加强肝切除手术患者肝功能的保护作用,降低患者体内炎症反应水平,未增加并发症发生率。

Objective To observe the influences of dexamethasone on liver function after hepatectomy in patients with primary liver cancer（PLC）. Methods 160 patients with PLC were randomly divided into observation group and control group with 80 cases each. Thepatients in control group received conventional therapy,and those in observation were treated with intravenous administration of dexamethasone for three days. Serum alanine aminotransferas （ALT）,aspartate aminotransferase （AST）,albumin（ALB）,total bilirubin（TBIL）,inflammatory cytokine hypersensitive C-reactive protein（hs-CRP）,interleukin-8（IL-8） levels and incidence of postoperative complications were recorded. Results At third and seventh day,serum ALT levels in observation group were （114.6±14.9） U/L and （50.2±6.7） U/L,respectively,much lower than in the control group [（279.2±21.2） U/L and （79.8±11.0） U/L, P〈0.05];serum AST levels were （141.2±16.0） U/L and （59.8±7.1） U/L,much lower than in the control group [（299.3±20.4） U/L and（85.5±12.4） U/L,P〈0.05];serum ALB levels were（34.8±1.6） g/L and （38.3±1.9） g/L,much higher than in control [（31.6±1.4） g/L and （35.0±1.8） g/L,P〈0.05];serum TBIL levels were （32.2±2.7）μmol/L and （27.1±2.4）μmol/L,much lower than in the control group [（36.2±3.1）μmol/L and （31.2±2.6）μmol/L,P〈0.05];at the end of first day and seventh day,serum hs-CRP levels in observation were （25.0±3.1） mg/L and （17.8 ±2.1） mg/L,much lower than in the control group （30.6±3.8） mg/L and （21.0±2.6） mg/L,P〈0.05];seerum IL-8 levels were （24.0±3.0） pg/ml and （14.0±1.9） pg/ml,much lower than in the control group [（28.6±3.7） pg/ml and （18.5±2.1） pg/ml,P〈0.05];the postoperative complication rate in＆amp;nbsp;observation was 35.0%,without significant difference in control （23.8%,P〉0.05）. Conclusion Dexamethasone can protect liver function in patients with PLC after hepatectomy,which might be related to the inhibition of inflammatory reactions.