胃癌根治术后肝功能异常的影响因素分析

Analysis of related factors of liver abnormalities after radical gastrectomy for gastric cancer

目的分析胃癌根治术后肝功能异常(LA)的相关影响因素。方法回顾性收集2018年6月至2020年12月择期行胃癌根治术的1013例患者临床资料,男699例,女314例,年龄24~92岁,ASAⅡ或Ⅲ级。根据术后第1天是否发生LA将患者分为两组:肝功能正常组(NLA组)和肝功能异常组(LA组)。LA定义为血清中以下任一肝酶浓度升高:谷丙转氨酶>40 U/L,谷草转氨酶>40 U/L,γ-谷氨酰转移酶>49 U/L,碱性磷酸酶>135 U/L,总胆红素>17.1μmol/L,直接胆红素>6.8μmol/L。比较两组临床资料,将P<0.15的指标纳入二元Logistic回归模型分析。结果术后第1天有577例(57.0%)患者发生LA。与NLA组比较,LA组肥胖、吸烟史、贫血、腹腔镜手术、输血、使用其他血管活性药物、使用酮咯酸氨丁三醇、高P_(ET )CO_(2)比例明显升高,晶体输注量、出血量、尿量、总入超量明显增多,输液速度明显减慢,多巴胺使用比例明显降低,手术时间明显延长(P<0.15)。二元Logistic回归分析显示,肥胖(OR=2.149,95%CI 1.241~3.720)、吸烟史(OR=1.913,95%CI 1.012~3.616)、使用酮咯酸氨丁三醇(OR=1.771,95%CI 1.025~3.060)、手术时间(每延长10 min,OR=1.148,95%CI 1.083~1.217)是术后LA的独立危险因素,总入超量(每增加100 ml,OR=0.872,95%CI 0.806~0.944)、尿量(每增加100 ml,OR=0.999,95%CI 0.998~1.000)、使用多巴胺(OR=0.500,95%CI 0.291~0.860)是术后LA的保护因素(P<0.05)。结论肥胖、吸烟史、酮咯酸氨丁三醇的使用、手术时间延长是术后LA的独立危险因素,合理的围术期输液管理及适量使用多巴胺以维持稳定的循环及尿量有利于保护肝功能。

Objective To analyze the related influencing factors of liver abnormalities(LA)after radical gastrectomy for gastric cancer.Methods The clinical data of 1013 patients undergoing radical gastrectomy from June 2018 to December 2020 were collected retrospectively,including 699 males and 314 females,aged 24-92 years,ASA physical statusⅡorⅢ.All the patients were divided into normal liver function group(group NLA)and abnormal liver function group(group LA)according to whether LA occurred on the first postoperative day.LA was defined as elevation of any of the following liver enzymes in serum:alanine aminotransferase>40 U/L,aspartate aminotransferase>40 U/L,gamma-glutamyltransferase>49 U/L,alkaline phosphatase>135 U/L,total bilirubin>17.1μmol/L,and direct bilirubin>6.8μmol/L.Clinical data were compared,and the univariate differences between the groups(P<0.15)were included in the binary logistic regression model analysis.Results The incidence of LA was 577(57%)on postoprative day 1.Compared with group NLA,group LA had increased proportion of smoking,obesity,anemia,laparoscopic surgery,blood transfusion,use of other vasoactive drugs,use of ketorolac tromethamine and higher P_(ET )CO_(2);much blood loss,urine volume,crystal infusion volume and total excess;lower speed of infusion;decreased proportion of dopamine use and operation time(P<0.15).Binary logistic regression analysis showed that obesity(OR=2.149,95%CI 1.241-3.720),preoperative smoking(OR=1.913,95%CI 1.012-3.616),use of ketorolac tromethamine(OR=1.771,95%CI 1.025-3.060),and operation time(for every 10 minutes elongated,OR=1.148,95%CI 1.083-1.217)were independent risk factors for postoperative abnormal liver function.Total overdose(for every additional 100 ml,OR=0.872,95%CI 0.806-0.944),urine volume(for every additional 100 ml,OR=0.999,95%CI 0.998-1.000),dopamine(OR=0.500,95%CI 0.291-0.860)were protective factors for abnormal liver function after operation(P<0.05).Conclusion Obesity,preoperative smoking,use of ketorolactotramine,and increased duration of surgery are independent risk factors for postoperative LA.Reasonable perioperative infusion management and appropriate use of dopamine to maintain stable circulation and urine volume are conducive to the protection of liver function.