传统生化指标动态监测在原位肝移植缺血再灌注损伤评价中的意义

The significance of dynamic monitoring of traditional biochemical indexes in the evaluation of ischemia-reperfusion injury in orthotopic liver transplantation

目的探讨传统生化指标的动态监测在原位肝移植缺血再灌注损伤评价中的意义。方法回顾性分析21例原位肝移植患者在术前、术中不同时期和术后5 d内血清丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)、乳酸脱氢酶(LDH)、血肌酐(Scr)、尿素氮(BUN)、胆碱酯酶(CHE)、总蛋白(TP)、白蛋白(ALB)、总胆汁酸(TBA)和总胆红素(TBIL)的动态变化规律。结果LDH在术中迅速升高,在肝门开放期上升至最高水平(P<0.05),术后5 d逐渐下降至正常范围。ALT、AST在术中升高并于手术结束升高至最高水平(P<0.05),术后5 d逐渐下降(P<0.05),AST在术后5 d基本接近正常值。TBIL、TBA在术中一直处于下降趋势(P<0.05),TBA在术后5 d恢复至正常水平。BUN在肝门开放期开始逐渐升高(P<0.05),术后4 d较前一时期开始下降。Scr水平在术中变化不明显,基本处于正常参考范围。TP在肝门阻断前开始降低(P<0.05),ALB则在术中无明显变化,二者均于术后2 d开始同步上升至接近正常值。CHE在术中及术后5 d无明显变化并始终低于正常水平。结论传统生化指标在原位肝移植术中的规律变化趋势,对于肝脏缺血再灌注损伤评价及肝功能恢复的评估具有重要意义。

Objective To investigate the significance of dynamic monitoring of traditional biochemical indexes in the evaluation of ischemia-reperfusion injury in orthotopic liver transplantation.Methods A total of 21 patients who underwent orthotopic liver transplantation were enrolled in the study.The serum levels of alanine aminotransferase(ALT),aspartate aminotransferase(AST),lactate dehydrogenase(LDH),creatinine(SCR),urea nitrogen(BUN),cholinesterase(CHE),total protein(TP),albumin(ALB),total bile acid(TBA)and total bilirubin(TBIL)before operation,during operation and at 5d after surgery were detected to analyze their dynamic change features.Results The LDH levels were increased rapidly during operation,which increased to the highest level at the period of porta hepatis opening(P<0.05),then gradually decreased to the normal range at 5d after operation.ALT and AST levels were increased during operation and reached the highest level at the end of operation,then decreased gradually at 5d after operation.AST was almost normal at 5d after operation.TBIL and TBA were in a downward trend during operation,TBA returned to normal level at 5d after operation.BUN began to increase gradually at the period of porta hepatis opening,and decreased at 4d after operation.However Scr levels had no significant changes during operation,basically in the normal reference range.TP began to decrease before hepatectomy,ALB had no significant changes during operation,both of them began to increase to the normal value at 2d after operation.CHE had no significant changes during operation and at 5d after operation.Conclusion The change trend of traditional biochemical indexes in patients undergoing orthotopic liver transplantation is of great significance in the evaluation of ischemia-reperfusion injury and liver function recovery.