百特5％及25％人血白蛋白在肝脏、胰腺手术围手术期应用的疗效和安全性  

The clinical research of 5 % and 25% human serum albumin （ALB） in postoperative recovery of patients after liver resection or pancreatic operation

作　　者：邓侠兴[1] 沈柏用[1] 吕文杰[1] 詹茜[1] 彭承宏[1] 李宏为[1] 

机构地区：[1]上海交通大学医学院附属瑞金医院肝胆胰中心,200025

出　　处：《中华肝胆外科杂志》2009年第3期192-195,共4页Chinese Journal of Hepatobiliary Surgery

摘　　要：目的观察百特5％及25％人血白蛋白在肝脏/胰腺围手术期合理分配应用的疗效和安全性。方法收集上海瑞金医院移植科2007年1至10月收治的40例胰腺及60例肝脏手术病人的临床资料，根据人血白蛋白使用情况分为白蛋白组（A组）．即从手术之日起每日予5％500ml或25％100ml人血白蛋白一支，连续使用9d生理盐水组（B组），即每日给予生理盐水。蛋白组又分为5％白蛋白使用组（A1组），即连续9d使用5％白蛋白，和5％、25％合并用药组（A2组），即术后1～5d使用5％白蛋白，术后6～9d使用25％白蛋白。其余治疗各组皆相同。比较各组病人术后肝肾功能、凝血功能、电解质以及胆瘘、胰漏、胸腹水量、伤口愈合时间及住院时间。结果白蛋白组术后病人血清白蛋白水平明显高于对照组，肝脏切除术后（术前Child Pugh A级及B级）白蛋白组PT、APTT均明显低于对照组，胰腺术后胆瘘、胰瘘的发生率明最低于对照组。对于术后胸腹水的产生，白蛋白组与对照组相比显著降低，而5％、25％合并用药组与5％白蛋白使用组相比则显著降低。术后白蛋白组伤口愈合不良发生率明显低于对照组，术后住院时间明显缩短。结论在肝脏／胰腺于术术后使用白蛋白能显著改善病人的肝肾、凝血功能，促进伤口愈合，减少相关并发症，缩短住院时间。术中及术后前期使用等渗性白蛋白溶液能纠正低白蛋白血症，术后后期使用高渗性白蛋白，在纠正低白蛋白血症的同时能显著减少水肿及胸腹水的发生。提示在肝脏／胰腺手术围手术期合理分配等渗性和高渗性白蛋白在纠正低蛋白血症的同时能更有效地改善体液分布，使之平衡，达到更佳的临床治疗效果。Objective To assess the effect and security of Baxter 5% and 25% human serum albumin （ALB） in postoperative recovery of patients after liver resection or pancreatic operation. Methods 40 patients undergoing pancreatic operation and 60 patients undergoing hepateetomy in our hospital frmn January to October in 2007 were randomized into two groups： group A, the treatment group, including the patients who were given Baxter 5% or 25% AI.B daily in operation day and 9 consecutive postoperative days, and group B, the control group ,including the patients who only received normal saline. The patients in group A were also randomized into two groups ：group A1 ,inclu ding the patients who were only given Baxter 5% ALB daily in operation day and 9 consecutive postop- erative days, and group B, including the patients who were given Baxter 5% ALB daily in operation day and 5 consecutive postoperative days and Baxter 25% ALB daily from 6th to 9th postoperative day. Comparisons were made postoperatively between the two groups with regard to related biochemi cal tests of liver function ,serum electrolytes and coagulating indicies, as well as clinical variables in cluding pancreatic or bile leak, ascites, pleural effusion, wound healing and in-hospital duration. Results Compared with group B, group A had higher level of albumin in serum and significantly shorter PT and APTT after liver resection following the treatment of ALB. Lower incidence of bile or pan creatic leak after pancreatic operation was observed in group A. Moreover,the prevalence and magni tude of postoperative ascites, pleural effusion were significantly decreased in group A and lower inci dence in A1. Undesirable wound healing and in hospital duration were also significantly decreasesd in group A. Conclusion As for patients undergoing liver resection or pancreatic operation, the use of ALB can markedly accelerate the restoration of liver and coagulating function reduce postoperative complication, promote wound healing and shorten in-hospital duration. 5% A

关 键 词：肝切除术 胰腺手术 肝功能 白蛋白 

分 类 号：R686[医药卫生—骨科学]