极化液在肝移植术围术期的临床应用

Perioperative clinical application of glucose-insulin-potassiumin in liver transplantation

目的观察术中输注极化液(GIK)在原位肝移植术(OLT)围术期防治高乳酸血症和改善预后中的作用。方法选择接受经典OLT的男性患者30例,年龄16~65岁,BMI 18~30 kg/m^2,ASAⅡ或Ⅲ级。随机分为极化液组(GIK组)和生理盐水组(NS组),每组15例。全麻诱导后GIK组以3 ml·kg^-1·h^-1速率输注GIK溶液,同时NS组以等速泵注生理盐水,直至手术结束时停止输注。两组术中均泵注50 ml包含50 U胰岛素的生理盐水,根据血糖维持在7.0~11.0mmol/L,调整泵注速度。分别于麻醉诱导前5 min(T0)、无肝期前1 h(T1),无肝期1 h(T2),门静脉开放后1 h(T3)、12 h(T4)、24 h(T5)行血气分析,记录HR、MAP、乳酸(Lac)、血糖(Glu)。记录两组患者手术时间、无肝期时间、术中输血量、拔管时间、ICU滞留时间、术后24 h ALT和AST等指标。结果 T0-T5时两组HR、MAP、Glu、K+差异无统计学意义。GIK组T2-T5时Lac明显低于NS组(P<0.05),术后ICU滞留时间明显短于NS组(P<0.05),两组术中手术时间、无肝期时间、术中输血量、术后拔管时间差异无统计学意义。术后24 h GIK组ALT和AST明显低于NS组(P<0.05)。结论术中输注极化液可以预防肝移植术围术期高乳酸血症,缩短ICU滞留时间,改善术后肝功能。

Objective To observe the effect of glucose-insulin-potassium(GIK) in prevention and treatment of hyperlacticacidemia and the improvement of prognosis during perioperative period of orthotopic liver transplantation(OLT). Methods Thirty male patients receiving classic OLT, aged 16-65 years, BMI 18-30 kg/m^2, ASA Ⅱ or Ⅲ, were randomly divided into glucose-insulin-potassium group(group GIK) and normal saline group(group NS), with fifteen patients in each group. After the induction of general anesthesia, patients in group GIK were given GIK solution intravenously at a rate of 3 ml·kg^-1·h^-1, while patients in group NS were given normal saline intravenously at the same rate until the end of the operation. In both groups, 50 ml of normal saline containing 50 U insulin was pumped during the operation, and the pumping speed was adjusted according to the blood glucose maintained between 7.0-11.0 mmol/L. Arterial blood gas analysis was performed 5 min before induction of anesthesia(T0), 1 h before anhepatic phase(T1), 1 h during anhepatic phase(T2), 1 h(T3), 12 h(T4) and 24 h(T5) after portal vein opening. And HR, MAP, lactic acid(Lac), and blood glucose(Glu) were recorded. The time of operation, the time of anhepatic stage, the amount of intraoperative blood transfusion, extubation time, ICU retention time, 24 h postoperative ALT and AST were recorded. Results Lac was significantly lower in the group GIK than in the group NS at T2-T5(P< 0.05). The ICU retention time was significantly shorter than that in group NS(P<0.05), and ALT and AST were significantly lower than those in the group NS at 24 h after surgery(P< 0.05). There was no significant difference in HR, MAP, Glu, K+, operation time, anhepatic time, intraoperative blood transfusion, and post-extubation time between the two groups. Conclusion Intraoperative infusion of GIK can prevent perioperative hyperlacticacidemia in perioperative period of liver transplantation, shorten ICU retention time, and improve liver function after operation.