肝硬变门静脉高压患者门腔静脉搭桥分流术前后血浆氨基酸谱的分析  

Perioperative plasma amino acid spectrum analysis in portal hypertensive cirrhotic patients undergoing portacaval H graft shunt

作　　者：朱继业[1] 柳枫[1] 冷希圣[1] 王新慧[1] 彭吉润[1] 杜如昱[1] 

机构地区：[1]北京医科大学人民医院外科

出　　处：《中华外科杂志》1997年第5期299-301,共3页Chinese Journal of Surgery

摘　　要：作者于１９９４年４月至１９９５年５月对１０例肝硬变门静脉高压和１０例无肝病胃肠手术患者进行了血浆氨基酸谱检测。１０例门静脉高压患者行８ｍｍ口径人工血管门腔搭桥分流术。分别于分流术前、术后即刻、术后１天、术后３天测定周围动脉、周围静脉、门静脉及肝静脉血浆氨基酸谱，胃肠手术组则于手术开始及术后３天测定。结果显示：胃肠组与分流组术后氨基酸水平均比术前下降，但分流组下降明显。支链氨基酸与芳香氨基酸之比（ＢＣＡＡ／ＡＡＡ）在分流术前小于２，对照则大于３，术前术后两组变化均不明显。在分流组患者肝静脉血中的ＢＣＡＡ及ＡＡＡ含量无论手术前后均高于其它部位；分流术后即刻ＢＣＡＡ及ＡＡＡ均比术前减少，其中ＢＣＡＡ中缬氨酸、亮氨酸减少明显。术后３天ＢＣＡＡ和ＡＡＡ恢复至术前水平。提示：小口径门体分流术对患者氨基酸谱变化无明显影响。Perioperative plasma amino acid spectrum (PAAS) was analysed in 10 portal hypertensive patients (PH) receiving portacaval H graft shunt (D=8mm) and 10 gastroenteropathic patients (GE) without hepatic disease.In both groups, arterial,peripheral and hepatic venous blood was drawn for analysis immediately pre and post operation on the table, postoperative day 1 and 3, respectively.It was found that amino acid concentration decreased in both groups but in PH group it was changed significantly.The preoperative branched chain amino acid (BCAA)/aromatic amino acid (AAA) ratio was less than 2 in the PH group and larger than 3 in the GE group after operation. The ratio did not change significantly in both groups after operation. In the PH group, the pre and post operative BCAA and AAA level in hepatic vein was higher than in other sites. The immediately BCAA and AAA levels were lower than preoperative levels. Among the changes the postoperative decrease of VAL and LEU was significant.Both BCAA and AAA reached preoperative level at postoperative day3. The results reveal that small diameter portacaval shunt has no significant influence on PAAS. The temporary decrease of amino acid levels postoperatively may be related to the stress of operation and liver impairement.

关 键 词：肝硬化 门体分流术 门脉高血压 氨基酸谱 

分 类 号：R657.340.5[医药卫生—外科学]