DCD肝移植结束时乳酸浓度及早期乳酸清除率测定的临床意义

Clinical Significance of Lactate Concentration and Early Lactate Clearance Determination at the End of DCD Liver Transplantation

目的:总结肝移植术后乳酸浓度及早期乳酸清除率对肝移植术后早期移植物功能不全(early allograft dysfunction, EAD)的预测价值。方法:通过查阅近年来国内外有关肝移植术后乳酸浓度及乳酸清除率测定指标研究的相关文献,并进行了综述这一方法,来进行表达。结果:肝移植手术规模庞大,手术操作复杂。在手术过程中,需要阻断肝脏的上下腔静脉和门脉,导致机体的血液流动减缓,氧气供应不足。这样会导致大量乳酸在体内生成并释放到血液中。肝脏移植后,随着肝功能的逐步恢复,肝脏对乳酸的处理能力逐渐增强,导致血液中乳酸水平逐渐降低并恢复到正常水平。术后乳酸浓度及早期乳酸清除率的应用,可以提前发现和识别肝移植手术后的早期移植相关性肝损伤(EAD)的发生和发展。这一方法能够使得对肝移植术后的EAD进行早期有效的干预成为可能。结论:血清乳酸水平具备便于测量和迅速获得的特点,并且可能是最早预测肝移植后早期移植功能障碍(EAD)的指标,有望成为一种可靠的生物学标志物。

Objective: To summarize the predictive value of lactate concentration and early lactate clearance on early allograft insufficiency (EAD) after liver transplantation. Methods: This method was expressed by reviewing the literatures about the determination indexes of lactic acid concentration and lactic acid clearance after liver transplantation in recent years. Results: The scale of liver transplantation was large and the operation was complicated. During the operation, the upper and lower vena cava and portal arteries need to be blocked in the liver, resulting in slower blood flow in the body and insufficient oxygen supply. This results in large amounts of lactic acid being produced in the body and released into the blood stream. After liver transplantation, with the gradual recovery of liver function, the liver processing capacity to lactate is gradually increased, resulting in the gradual re-duction of the lactate level in the blood and the return to normal levels. The application of postop-erative lactate concentration and early lactate clearance can detect and identify the occurrence and development of early transplant-related liver injury (EAD) after liver transplantation surgery in advance. This approach is able to enable early and effective intervention for EAD after liver trans-plantation. Conclusion: Serum lactate level is easy to measure and rapid acquisition, and may be the earliest indicator to predict early allograft dysfunction (EAD) after liver transplantation, which is expected to be a reliable biological marker.