本文選題：特利加壓素　切入點(diǎn)：肝癌合并乙肝肝硬化　出處：《山東大學(xué)》2017年碩士論文

【摘要】：目的:本研究旨在討論對(duì)肝癌合并乙肝肝硬化患者(術(shù)后病理證實(shí))行肝癌切除術(shù)后應(yīng)用特利加壓素療效效果,從而尋找加速肝癌合并乙肝肝硬化患者術(shù)后恢復(fù)、減少術(shù)后并發(fā)癥的方法。資料與方法:本研究選取山東省立醫(yī)院器官移植肝膽外二科2016.05-2016.12收治的100例肝癌合并乙肝肝硬化患者,使用隨機(jī)表法隨機(jī)分為實(shí)驗(yàn)組及對(duì)照組。兩組患者的性別、年齡、術(shù)前血紅蛋白、凝血酶原時(shí)間、總膽紅素、手術(shù)時(shí)間、術(shù)中出血量及肝門阻斷時(shí)間均無明顯統(tǒng)計(jì)學(xué)差異。實(shí)驗(yàn)組(特利加壓素組)于術(shù)后當(dāng)天開始,常規(guī)預(yù)防性使用特利加壓素2mg/d,使用0.9%氯化鈉溶液40ml溶解,24小時(shí)持續(xù)泵入,應(yīng)用最長時(shí)間不超過12d;對(duì)照組(非特利加壓素組)采用傳統(tǒng)的利尿劑(螺內(nèi)酯、呋塞米)、多巴胺治療。分別于術(shù)后第一、第三及第五天空腹時(shí)靜脈采血測(cè)定兩組患者的總膽紅素(T-bil)、丙氨酸氨基轉(zhuǎn)移酶、天冬氨酸氨基轉(zhuǎn)移酶、肌酐、尿素氮,同時(shí)記錄兩組患者腹腔引流管拔管時(shí)間、胸腔積液發(fā)生數(shù)及出院時(shí)間,并使用SAS軟件分析兩組差異,從而對(duì)術(shù)后應(yīng)用特利加壓素的效果進(jìn)行評(píng)價(jià)分析。結(jié)果:兩組患者術(shù)后第一天實(shí)驗(yàn)組總膽紅素、丙氨酸氨基轉(zhuǎn)移酶、天冬氨酸氨基轉(zhuǎn)移酶、肌酐、尿素氮水平為別為30.8023±3.06435 umol/L、370.51 ±43.762 U/L、482.14±48.126U/L、65.240±3.4698umol/L.6.24±0.399mmol/L;對(duì)照組總膽紅素、丙氨酸氨基轉(zhuǎn)移酶、天冬氨酸氨基轉(zhuǎn)移酶、肌酐、尿素氮水平為別為36.8396±5.41013umol/L、433.54±55.070U/L、483.22±54.129U/L、66.190±3.2626umol/L、6.35±0.394mmol/L,兩組之間各指標(biāo)無顯著性差異(P0.05)。術(shù)后第三天實(shí)驗(yàn)組總膽紅素(T-bil)、丙氨酸氨基轉(zhuǎn)移酶、天冬氨酸氨基轉(zhuǎn)移酶、肌酐、尿素氮水平分別為39.523±3.4553umol/L、97.66±15.5U/L、205.30±28.317U/L、61.94±2.855umol/L、6.933±0.4423 mmol/L,對(duì)照組總膽紅素、丙氨酸氨基轉(zhuǎn)移酶、天冬氨酸氨基轉(zhuǎn)移酶、肌酐、尿素氮水平為別為54.207±5.7861umol/L、150.16±21.4U/L、261.84±43.882U/L、71.25±3.350umol/L、7.430±0.3138mmol/L,兩組各個(gè)數(shù)據(jù)之間存在統(tǒng)計(jì)學(xué)差異(P= 0.0027,0.0439,0.0454,0.0366,0.0365);術(shù)后第五天實(shí)驗(yàn)組總膽紅素、丙氨酸氨基轉(zhuǎn)移酶、天冬氨酸氨基轉(zhuǎn)移酶、肌酐、尿素氮水平分別為33.284±4.0263umol/L、59.00±8.827U/L、86.73± 12.702U/L、62.23±2.084umol/L、5.943±0.3276 mmol/L,對(duì)照組總膽紅素、丙氨酸氨基轉(zhuǎn)移酶、天冬氨酸氨基轉(zhuǎn)移酶、肌酐、尿素氮水平為別為54.963±6.8413umol/L、69.47±6.225U/L、122.17±24.010U/L、69.52±3.747umol/L、7.186±0.4525mmol/L,兩組各個(gè)數(shù)據(jù)之間存在統(tǒng)計(jì)學(xué)差異(P=0.0001,0.0002,0.0210,0.0196,0.0317)。實(shí)驗(yàn)組腹腔引流管拔管時(shí)間(7.31 ±0.554天)明顯少于實(shí)驗(yàn)組拔管時(shí)間(8.25±0.667天)(p=0.034);實(shí)驗(yàn)組胸腔積液發(fā)生例數(shù)(1例)明顯少于對(duì)照組患者胸腔積液發(fā)生例數(shù)(7例)(p=0.045);實(shí)驗(yàn)組住院天數(shù)(10.03±0.256 天)少于對(duì)照組(11.23±0.335 天)(p=0.041)。結(jié)論:本研究顯示特利加壓素的應(yīng)用能夠改善肝癌合并乙肝肝硬化患者術(shù)后的肝腎功能,縮短術(shù)后腹腔引流管拔管天數(shù),減少胸腔積液的發(fā)生率、縮短住院天數(shù)。提示肝癌合并乙肝肝硬化患者行肝癌切除術(shù)后應(yīng)用特利加壓素可以減少其并發(fā)癥的發(fā)生,同時(shí)加速其恢復(fù)。
[Abstract]:Objective: the purpose of this study is to discuss the hepatocellular carcinoma patients with liver cirrhosis (thepostoperativepathology) curative effect of vasopressin for application. After resection of hepatocellular carcinoma, in order to find the acceleration of HCC patients with liver cirrhosis after recovery, reduce the postoperative complications. Materials and methods: This study selected two Department of hepatobiliary surgery Shangdong Province-owned Hospital organ transplant 2016.05-2016.12 a total of 100 cases of hepatocellular carcinoma complicated with liver cirrhosis patients, using randomly divided into experimental group and control group. Two groups of patients with gender, age, preoperative hemoglobin, total bilirubin, prothrombin time, operation time, intraoperative blood loss and hepatic portal occlusion time has no significant difference between the experimental group (terlipressin. In group A) on postoperative day, routine prophylactic use of terlipressin in 2mg/d, using Sodium Chloride Solution 40ml 0.9% dissolved, 24 hours continuous pumping, the longest time the application No more than 12D; the control group (non terlipressin group) using conventional diuretics (spironolactone and furosemide), dopamine treatment. After operation respectively the first, third and five of the sky when the abdominal venous blood determination of total bilirubin in the patients of the two groups (T-bil), alanine aminotransferase, aspartate aminotransferase at the same time, creatinine, urea nitrogen, records of two patients of abdominal drainage tube extubation time, pleural effusion and the number of discharge time, and analyze the differences between the two groups using the SAS software, so as to evaluate the effect of vasopressin application after operation. Results:. Two groups of patients after the first day of the experimental group total bilirubin, alanine aminotransferase, aspartate aminotransferase, creatinine, urea nitrogen level was 30.8023 + 3.06435 umol/L 370.51 + 43.762 U/L, 482.14 + 48.126U/L, 65.240 + 3.4698umol/L.6.24 + 0.399mmol/L; control group, total bilirubin, alanine Y-ggt, aspartate aminotransferase, creatinine, urea nitrogen respectively was 36.8396 + 5.41013umol/L, 433.54 + 55.070U/L, 483.22 + 54.129U/L, 66.190 + 3.2626umol/L, 6.35 + 0.394mmol/L, there was no significant difference between the two groups of each index (P0.05). After third days the experimental group total bilirubin (T-bil). Alanine aminotransferase, aspartate aminotransferase, creatinine, urea nitrogen levels were 39.523 + 3.4553umol/L, 97.66 + 15.5U/L, 205.30 + 28.317U/L, 61.94 + 2.855umol/L, 6.933 + 0.4423 mmol/L, control group, total bilirubin, alanine aminotransferase, aspartate aminotransferase, creatinine, urea nitrogen level to do was 54.207 + 5.7861umol/L, 150.16 + 21.4U/L, 261.84 + 43.882U/L, 71.25 + 3.350umol/L, 7.430 + 0.3138mmol/L, there were significant differences between the two groups (P= 0.0027,0.0439,0.0454,0.0366,0.0365); all data after fifth days of experimental group Total bilirubin, alanine aminotransferase, aspartate aminotransferase, creatinine, urea nitrogen levels were 33.284 + 4.0263umol/L, 59 + 8.827U/L, 86.73 + 12.702U/L, 62.23 + 2.084umol/L, 5.943 + 0.3276 mmol/L, control group, total bilirubin, alanine aminotransferase, aspartate aminotransferase, creatinine, urea nitrogen the level is not as 54.963 + 6.8413umol/L, 69.47 + 6.225U/L, 122.17 + 24.010U/L, 69.52 + 3.747umol/L, 7.186 + 0.4525mmol/L, there were significant differences between the two groups (P= 0.0001,0.0002,0.0210,0.0196,0.0317). The data of the experimental group of abdominal drainage tube extubation time (7.31 + 0.554 days) was significantly less than the experimental group extubation time (8.25 + 0.667 days) the experimental group (p=0.034); the incidence of pleural effusion (1 cases) was significantly less than the control group of patients with pleural effusion cases (7 cases) (p=0.045); the experimental group hospitalization time (10.03 + (0.256 days) than in the control group 11.23 + 0.335 days) (p=0.041). Conclusions: This study shows that terlipressin application can improve kidney function in patients with hepatocellular carcinoma after liver cirrhosis, shorten the extubation time of abdominal drainage after operation, reduce the incidence of pleural effusion, shorten the hospitalization days. Tips for liver cancer patients after resection of hepatocellular carcinoma with hepatitis B cirrhosis terlipressin can reduce the incidence of complications, and to accelerate its recovery.

【學(xué)位授予單位】：山東大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R735.7;R512.62;R575.2

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