体外循环心脏手术患者肝功能的表达水平及腺苷蛋氨酸的干预机制研究

Expression Level of Liver Function in Patients of Cardiac Surgery with Cardiopulmonary Bypass and Intervention Mechanism of Ademetionine

目的:探讨体外循环心脏手术患者肝功能的表达水平及腺苷蛋氨酸的干预机制。方法:选取2017年5月至2018年6月在海南医学院第二附属医院接受体外循环心脏手术的患者184例,根据随机数字表法分为观察组及对照组各92例,分别比较术前、术后所有患者肝功能指标水平。术后对照组患者给予生理盐水干预7d,观察组患者给予腺苷蛋氨酸干预7d,比较两组患者干预7d后肝功能指标、炎症反应指标以及心肌损伤指标水平。结果:术前患者的总胆红素(TBI)、直接胆红素(DBI)、丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)水平均显著低于术后,差异均有统计学意义(P<0.05)。干预7d后观察组患者的TBI、DBI、ALT、AST、血清肿瘤坏死因子-α(TNF-α)、白细胞介素-8(IL-8)、肌酸激酶同工酶(CK-MB)、肌钙蛋白(cTnT)水平均显著低于对照组,而白细胞介素-10(IL-10)水平显著高于对照组,差异均有统计学意义(P<0.05)。观察组不良反应发生率为7.61%(7/92),与对照组的2.17%(2/92)相比,差异无统计学意义(P>0.05)。结论:体外循环心脏手术会对患者肝功能造成一定程度的损害,而腺苷蛋氨酸对患者的肝功能以及心肌组织均有一定的保护作用,同时能减轻炎症反应程度,无严重药物不良反应发生。

Objective: To study the expression level of liver function in patients of cardiac surgery with cardiopulmonary bypass and the intervention mechanism of ademetionine. Methods: A total of 184 patients underwent cardiopulmonary bypass surgery in the Second Affiliated Hospital of Hainan Medical University from May 2017 to June 2018 were selected, and were divided into observation group and the control group according to random number table method, with 92 cases in each group. The liver function indexes levels of all the patients before and after operation were compared respectively. After surgery, the patients in the control group were given saline intervention for 7d, and the patients in the observation group were given ademetionine intervention for 7 d. The liver function indexes,inflammatory response indexes and myocardial injury indexes between the two groups were compared after seven days of intervention.Results: The total bilirubin(TBI), direct bilirubin(DBI), alanine aminotransferase(ALT), aspartate aminotransferase(AST) levels before surgery were significantly lower than those after surgery, the differences were statistically significant(P <0.05). After seven days of intervention, the TBI, DBI, ALT, AST, serum tumor necrosis factor-α(TNF-α) and interleukin-8(IL-8), creatine kinase isoenzyme(CK-MB), cardiac troponin T(cTnT) levels of observation group were significantly lower than those of the control group,and the interleukin-10(IL-10) level of observation group was significantly higher than that of the control group, the differences were statistically significant(P <0.05). The incidence of adverse reactions in the observation group was 7.61%(7/92), and there was no significant difference compared with 2.17%(2/92) in the control group(P>0.05). Conclusion: Cardiopulmonary bypass surgery can cause some damage to liver function, but ademetionine has certain protective effect in the patients’ liver function and myocardial tissue and can reduce the degree of inflammatory reaction at the same time, without serious adverse drug reaction.