前列地尔促进移植肝功能早期恢复的临床研究

Application of prostaglandin E1 improves graft viability in the immediate period after liver transplantation

目的 探讨前列地尔对术后早期移植肝功能恢复的影响。方法 对 6例肝移植患者从术中开始通过中心深静脉用微量泵给予前列地尔 (治疗组 ) ,术后同法持续 2 4h给予 ,拔除中心静脉插管后通过外周静脉缓慢输注 ,直至术后 2 0d ;另有 4例除不用前列地尔外 (对照组 ) ,其余处理同治疗组。观察两组患者术后 2 1d内的血清丙氨酸转氨酶 (ALT)、天冬氨酸转氨酶 (AST)、总胆红素 (TBil)和直接胆红素 (DBil)水平 ,记录胆汁引流量 ;记录各例术后在重症监护病房的留置时间。结果 术后第 1d两组患者的ALT和AST水平均显著升高 ,但治疗组显著低于对照组 (P <0 .0 1) ,3～ 5d后前述指标均迅速恢复至正常水平 ;两个组术后血清TBil和DBil均开始缓慢升高 ,但治疗组的水平明显低于对照组 (P <0 .0 5 ) ,且升高持续时间也短于对照组 (P <0 .0 5 ) ;治疗组的胆汁引流量显著多于对照组 (P <0 .0 5 ) ,需要重症监护的时间显著短于对照组 (P <0 .0 1)。结论 术后早期应用前列地尔对促进移植肝功能的早期恢复有积极意义。

Objective To study the cytoprotective effect of prostaglandin E1(PGE1)in the imme- diate period after orthotopic liver transplantation (OLT).Methods Ten patients undergoing OLT were divided into 2 groups: group P (n=6) was administered with PGE1 and group C (n=4) served as control group. Serum ALT, AST, TBIL, DBIL, bile output and the period of intensive care unit (ICU) in both groups were observed in the first 3 weeks after OLT. Results Postoperative increases in serum ALT, AST, TBIL and DBIL levels were significantly suppressed by PGE1. In addition, PGE1 contributed distinctly to an increase of bile output (P< 0.05) and a decrease of stay time in intensive care unit (ICU) (P< 0.01). Conclusion The PGE1 application reduces hepatocellular damage due to cold ischemia and reperfusion injury in OLT, and improves early graft viability.