原发性肝癌肝切除患者术后不同种类血浆输注疗效的回顾性分析

Retrospective Analysis of the Efficacy of Postoperative Plasma Transfusion in Patients with Primary Liver Cancer Undergoing Liver Resection

目的比较输注新鲜冰冻血浆与病毒灭活血浆对原发性肝癌肝切除患者术后肝功能及凝血功能的恢复是否有着明显的疗效差别。方法回顾性分析了我院2020年1月1日—2023年12月31日因原发性肝癌行肝部分切除术住院患者394例,按照输注的血浆种类不同将患者分为两组,分别为新鲜冰冻血浆组(n=128)及病毒灭活血浆组(n=266),通过倾向得分匹配法(propensity score matching,PSM)平衡两组患者的基线数据,并对匹配后患者的术前,术后以及输注血浆后的肝功能指标谷丙转氨酶(ALT)、谷草转氨酶(AST)、胆碱酯酶(CHE)、总胆红素(TBIL)、血浆总蛋白(TP)、白蛋白(ALB),凝血功能相关指标凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)以及预后情况(住院时间,出院评估)来评估其血浆输注的疗效。结果PSM后共有88对患者纳入统计,分别为新鲜冰冻血浆组(n=88)及病毒灭活血浆组(n=88),与术前结果相比,术后两组患者的肝功能与凝血功能均有明显受损;血浆输注后均可改善患者肝功能指标以及凝血功能;新鲜冰冻血浆组输浆后的ALT,AST,CHE,TBIL指标与病毒灭活血浆组输浆后指标相比,差异均无统计学意义;通过前后差值比较法我们发现,新鲜冰冻血浆组患者输浆前后的TP差值5.75(2.96,8.15)与ALB差值5.01(3.20,9.20)大于病毒灭活血浆组患者输浆前后的TP差值1.20(0.75,3.12)与ALB差值3.35(0.50,5.98)(P<0.05),新鲜冰冻血浆可以较好地恢复患者血浆蛋白水平;输注新鲜冰冻血浆后可以明显缩短APTT与PT延长时间,新鲜冰冻血浆组患者输浆前后的PT差值3.60(2.40,10.10)与APTT差值12.00(4.10,18.67)大于病毒灭活血浆组患者输浆前后的PT差值1.10(0.10,3.30)与APTT差值1.70(0.20,6.38)(P<0.05);与病毒灭活血浆组平均住院时间相比,新鲜冰冻血浆组的平均住院时间较长(26.07±1.92天)(P<0.05),但两组出院评估间差异无统计学意义(P=0.839)。结论原发性肝癌患者在肝切除术后输注新鲜冰冻血浆和病毒灭活血浆均可促进患者肝脏功能的恢复;新鲜冰冻血浆的输注对改善患者预后无明显优势,但是对于术后凝血功能异常的患者,新鲜冰冻血浆的输注可以更好地改善患者凝血功能并升高患者血浆蛋白水平。

Objective To compare the efficacy of fresh frozen plasma infusion and virus inactivated frozen plasma infusion on the recovery of liver function and coagulation function in patients with primary liver cancer after hepatectomy.Methods A retrospective analysis was conducted on 394 inpatients who underwent partial hepatectomy for primary liver cancer in our hospital from January 1,2020 to December 31,2023.Based on the types of plasma transfused,the patients were categorized into two groups:the fresh frozen plasma group(n=128)and the virus inactivated frozen plasma group(n=266).Baseline data of the two groups were balanced by propensity score matching(PSM),and the preoperative data of the matched patients were analyzed.Liver function indicators such as alanine aminotransferase(ALT),aspartate aminotransferase(AST),cholinesterase(CHE),total bilirubin(TBIL),plasma total protein(TP),and albumin(ALB)after surgery and after plasma infusion,prothrombin time(PT),activated partial thromboplastin time(APTT),and prognosis(length of hospital stay,discharge assessment)were utilized to evaluate the efficacy of plasma infusion.Measurement data following a normal distribution were presented as the mean±standard deviation(±x s),a T-test was employed for inter-group comparison,M(Q1,Q3)was adopted for inter-group comparison,U test was utilized for inter-group comparison,and aχ^(2) test was applied for inter-group comparison of count data.Results A total of 88 pairs of patients were included in the statistics after PSM,including fresh frozen plasma group(n=88)and virus inactivated frozen plasma group(n=88).Compared with the preoperative results,both groups of patients showed significant impairment in liver function and coagulation function after surgery;Plasma infusion can improve patients'liver function indicators and coagulation function;There was no significant difference in the indicators of ALT,AST,CHE,and TBIL between the fresh frozen plasma group and the virus inactivated frozen plasma group after transfusion;Through the comparison of the difference between before and after transfusion,we found that the difference in TP 5.75(2.96,8.15)and ALB 5.01(3.20,9.20)in the fresh frozen plasma group was greater than the difference in TP 1.20(0.75,3.12)and ALB 3.35(0.50,5.98)in the virus inactivated frozen plasma group(P<0.05);After infusion of fresh frozen plasma,the APTT and PT extension time were significantly shortened.The PT difference of 3.60(2.40,10.10)and APTT difference of 12.00(4.10,18.67)in the fresh frozen plasma group before and after plasma transfusion were greater than the PT difference of 1.10(0.10,3.30)and APTT difference of 1.70(0.20,6.38)in the virus inactivated frozen plasma group before and after plasma transfusion(P<0.05);Compared with the average hospitalization time of the virus inactivated frozen plasma group,the average hospitalization time of the fresh frozen plasma group was longer(26.07±1.92)days(P<0.05),but there was no statistical significance between the two groups in terms of discharge evaluation(P=0.839).Conclusion In patients with primary liver cancer who have undergone hepatectomy,the administration of fresh frozen plasma and virus inactivated frozen plasma can significantly promote the recovery of liver function;The infusion of fresh frozen plasma has no significant advantage in improving patient prognosis,but for patients with postoperative coagulopathy,the infusion of fresh frozen plasma can better improve their coagulation function and increase their protein levels.