不同肝功能患者肝移植术中血糖、胰岛素和胰高血糖素的变化及相关性  

Changes and correlations of glucose, insulin and glucagon in peri-operative period of liver transplantation in patients with different liver function

作　　者：关健强[1] 蔡珺[1] 罗刚健[1] 黑子清[1] 陈秉学[1] 

机构地区：[1]中山大学附属第三医院麻醉科,广东广州510630

出　　处：《中国现代医学杂志》2008年第17期2560-2563,2566,共5页China Journal of Modern Medicine

基　　金：广东省科技计划项目(No:2006B36003019)

摘　　要：目的观察不同肝功能患者行肝移植术中血糖、胰岛素、胰高血糖素的变化及其相关性。方法终末期肝病拟行肝移植患者30例,按Child分级分为A、B、C组、每组10例,静脉吸入复合全身麻醉下行改良背驮式肝移植。于麻醉前、无肝前期、无肝期25min,下腔静脉开放后5、30、60min、手术结束时采集动脉血测定血糖(BG)、血胰岛素和胰高血糖素。结果肝移植术中血糖、胰岛素、胰高血糖素变化显著,患者术中血糖、胰岛素、胰高血糖素在组内差异有显著性(P>0.01),组间随着Child分级增加可见血糖、胰岛素、胰高血糖素增高,但只有胰高血糖素变化在组间差异有显著性(P<0.01)。术前及无肝前期胰岛素水平和血糖水平呈正相关,r=0.542P<0.01;新肝期(新肝5、30、60及术毕)胰岛素水平和血糖水平无相关,r=0.171P=0.06。结论肝移植围术期血糖、胰岛素及胰高血糖素变化显著,肝功能ChildB级以上患者术前常伴有胰岛素血症及胰高血糖素血症,高胰高血糖素血症在重症肝炎患者肝移植围术期有重要意义。[Objective] To investigate the changes and correlations of glucose, insulin and glucagons in peri-operative period of liver transplantation （POPLT） in patients with different liver function. [Methods] 30 patients un- dergoing OLT were divided into Child A group （n=10）, Child B group （n=10） and Child C group （n=10） according their liver function. Blood samples were taken from artery in time point of before operation, before cross-clamping of portal vein, 25 min during anhepatic stage, 5, 30 and 60min after reperfusion and at the end of surgery for deter- ruination of plasma glucose, insulin and glucagons concentration. [Results] In each group, the blood glucose of pa- tients in perioperative period have changed distinctly. As compared with pre-operation, blood glucose in preanhepat- ie stage has significantly increased （P 〈0.01）. In neohepatic stage, blood glucose has further increased （P 〈0.01）, the highest reached 18.5 mmol/L. The blood glucose continue to increase until the neohepatie stage 60-minute. Com- pared with the noohepatie stage 5-minute, 40% （12/30） of patients with blood glucose levels were significantly de- creased, but it is still far higher than before the operation （P 〈0.01） and the other remained at a high level of blood glucose, even has a rising trend. No hypoglycemia has been found. Among groups, five patients have high blood glucose （〉7.8 mmol/l） at preoperative blood test, in which, the four eases from Group C with liver dysfunction. No sig- nificant difference has found among the groups and other different time-point. The insulin levels changed significantly （P 〈0.01） during the perioperative period. The insulin levels has a notable drop at anhepatic stage 25-minute and further decrease at neohepatie stage 30-minute （P 〈0.01）. But insulin level of all patients in perioperative period were not lower than the reference value. The patients in group B and C have a higher insulin level, but no significant difference （P =0.05） among the

关 键 词：原位肝移植 高血糖 胰岛素 胰高血糖素 

分 类 号：R617[医药卫生—外科学]