【摘要】：目的:對擬通過肝血流阻斷切除腫瘤的患者預先給予短期(24 h)禁食預處理,觀察其對術后發(fā)生的肝臟缺血/再灌注(ischemia reperfusion,I/R)損傷的保護作用。方法:采用前瞻性隨機對照研究,收集2015年10月至2016年5月南京醫(yī)科大學第一附屬醫(yī)院收治的肝功能Child-Pugh分級均為A級、擬行肝臟部分切除術的80例患者,按隨機數余數法分為實驗組(術前禁食24 h、禁飲8 h)和對照組(常規(guī)術前禁食、禁飲),再將兩組患者按腫瘤直徑及阻斷時間分組,于術前和術后(1、3、7 d)測定血清丙氨酸轉氨酶(ALT)、天門冬氨酸轉氨酶(AST)、總膽紅素(TBil)、直接膽紅素(DBil)、總蛋白、白蛋白(ALB)水平。結果:術后兩組患者ALT、AST、TBil、DBil明顯升高,實驗組患者術后1、3、7 d血清ALT水平明顯低于對照組,有統(tǒng)計學差異(P0.05),實驗組患者術后1、3 d的TBil、DBil均不同程度的低于對照組(P0.05)。兩組患者術后3、7 d總蛋白及白蛋白無明顯統(tǒng)計學差異(P0.05)。兩組患者術后并發(fā)癥發(fā)生率無明顯統(tǒng)計學差異(P0.05)。無論腫瘤直徑是否5 cm,無論阻斷時間是否20 min,實驗組術后(1、3 d)ALT水平都較對照組降低(P0.05)。結論:入肝血流阻斷肝部分切除術可造成一定程度的肝臟缺血再灌注損傷;短期禁食可能通過抑制肝臟缺血再灌注損傷后炎癥因子的釋放、增加抗炎因子產生、增加自噬效應,減輕肝組織損傷,從而保護肝臟缺血再灌注損傷。
[Abstract]:Aim: to observe the protective effect of short-term (24 h) fasting preconditioning on hepatic ischemia / reperfusion (ischemia reperfusion,I/R) injury in patients undergoing hepatic blood flow occlusion. Methods: a prospective randomized controlled study was conducted in 80 patients with liver function Child-Pugh grade A who were admitted to the first affiliated Hospital of Nanjing Medical University from October 2015 to May 2016. According to the method of random remainder, the patients were divided into two groups: experimental group (fasting 24 hours before operation, no drinking for 8 hours) and control group (routine fasting before operation, no drinking). The two groups were divided into two groups according to tumor diameter and blocking time. Serum alanine aminotransferase (ALT), aspartate transaminase (AST), total bilirubin (TBil), direct bilirubin (DBil), total protein and albumin (ALB) were measured before and 7 days after operation. Results: ALT,AST,TBil,DBil was significantly increased in the two groups. The serum ALT level in the experimental group was significantly lower than that in the control group on the 7th day after operation (P0.05). The TBil,DBil of the experimental group was lower than that of the control group in different degree on the 3rd day after operation (P0.05). There was no significant difference in total protein and albumin between the two groups 3 days after operation (P0.05). There was no significant difference in the incidence of postoperative complications between the two groups (P0.05). No matter whether the tumor diameter was 5 cm, or not, the level of 3 d) ALT in the experimental group was lower than that in the control group (P0.05). Conclusion: partial hepatectomy can induce liver ischemia reperfusion injury, and short term fasting may increase anti-inflammatory factor production and autophagy effect by inhibiting the release of inflammatory factors after hepatic ischemia reperfusion injury. To reduce liver tissue injury and protect liver from ischemia reperfusion injury.
【作者單位】： 南京醫(yī)科大學第一附屬醫(yī)院肝臟外科/肝臟移植中心國家衛(wèi)生和計劃生育委員會活體肝移植重點實驗室;
【基金】：國家自然科學基金項目面上項目(81273262)
【分類號】：R657.3

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