术中麻醉管理对肝癌患者术后丙氨酸转氨酶恢复的影响

The effect of perioperative anesthesia management on alanine aminotransferase recovery in patients with liver cancer

目的探讨术中影响肝癌患者术后丙氨酸转氨酶(ALT)恢复的麻醉相关因素。方法收集接受根治性手术治疗的177例肝癌患者临床资料。术后第5天ALT恢复正常或小于术前值的患者归为ALT恢复组(n=78),ALT未恢复正常且高于术前值的患者归为ALT未恢复组(n=99)。使用单因素分析及Logistic回归,筛选出影响术后ALT恢复的独立危险因素。结果ALT恢复组中术后第5天ALT值、中心静脉压(CVP)降低值和乳酸升高值低于ALT未恢复组,ALT恢复组中切除范围超过3个肝段和术后体温<35.5℃的患者占比低于ALT未恢复组,而手术时间≤180 min的患者占比高于ALT未恢复组(P<0.05)。Logistic回归分析显示,术后乳酸升高值较高(OR=1.526,95%CI:1.105~2.107)、CVP降低值较高(OR=1.170,95%CI:1.017~1.346)、手术切除范围较高超过3个肝段(OR=2.487,95%CI:1.185~5.216)是ALT未恢复的独立危险因素。结论术后乳酸升高值、手术切除范围超过3个肝段、CVP降低值影响肝癌患者术后ALT恢复。

Objective To explore the related factors of anesthesia that affect the recovery of alanine aminotransferase(ALT)in patients after hepatectomy.Methods Clinical data of 177 liver cancer patients underwent hepatectomy were retrospectively collected.Patients whose ALT returned to normal or less than the preoperative baseline on the fifth postoperative day were classified as ALT recovery group(n=78).Patients whose ALT did not return to normal and was higher than the preoperative baseline were classified as ALT un-recovery group(n=99).Single factor analysis and binary Logistic regression were conducted to screen out the independent risk factors of ALT recovery.Results The median value of ALT,central venous pressure(CVP)and lactate were lower in ALT recovery group on the fifth day after operation than those in the ALT un-recovery group.The proportion of patients with resection range exceeding 3 liver segments and postoperative body temperature<35.5℃was lower in the ALT recovery group than that of the ALT un-recovery group,while the proportion of patients with operation time≤180 min was higher in the ALT recovery group than that in the ALT un-recovery group(P<0.05).Binary Logistic regression showed that higher postoperative lactate level(OR=1.526,95%CI:1.105-2.107),lower CVP(OR=1.170,95%CI:1.017-1.346)and resection range exceeding 3 liver segments(OR=2.487,95%CI:1.185-5.216)were independent risk factors of ALT recovery.Conclusion The increased value of lactate after surgery,the decreased value of CVP and large range of hepatic resection may affect the recovery of ALT in patients with liver cancer.