肝硬化门静脉高压症患者围手术期血浆内毒素变化的临床研究  

Clinical research of the alteration of plasma endotoxin in perioperative patients with liver cirrhosis and portal hypertension

作　　者：孙晓飞[1] 李泓杰[1] 徐庆[1] 

机构地区：[1]上海交通大学医学院附属仁济医院普外科,200127

出　　处：《中华临床医师杂志（电子版）》2013年第8期48-51,共4页Chinese Journal of Clinicians(Electronic Edition)

基　　金：上海市教委资助项目(13yz040)

摘　　要：目的研究肝硬化门静脉高压症患者围手术期血浆内毒素的变化,评估血浆内毒素对患者预后的影响。方法分析我科于2010年3月至2012年1月期间收治的57例肝硬化门静脉高压症患者的临床资料。分别于入院、术后3、7、14d时抽血测定血浆内毒素水平,术前进行Child-Pugh分级,测定血常规、肝肾功能、出凝血系列,统计手术时间、术后住院天数和并发症的发生情况。结果肝硬化门静脉高压症患者血浆内毒素[(27.22±5.42)pg/ml]显著高于正常对照组[(1.31±0.21)pg/ml];肝硬化门静脉高压症患者的内毒素水平与Child-Pugh评分(r=0.261,P<0.05)、总胆汁酸(r=0.129,P<0.05)呈正相关,与血浆白蛋白水平呈负相关(r=-0.265,P<0.05),伴腹水组[(57.42±19.75)pg/ml]较不伴腹水组[(16.45±1.71)pg/ml]明显升高;门静脉高压症患者内毒素平均值(术前,术后3、7、14d)与手术时间(r=0.208,P<0.05)和术后住院天数(r=0.297,P<0.05)呈正相关;无并发症者术后3、7、14d的内毒素水平较有并发症者存在显著差异(P均<0.05),其中感染相关并发症患者内毒素水平高于其他并发症患者(P<0.05)。结论肝硬化门静脉高压患者存在内毒素血症,随肝硬化程度加重而加重,另外内毒素血症与门静脉高压症术后并发症相关,对评估患者短期预后有一定的指示作用。Objective To study the level of plasma endotoxin change of perioperative patients with portal hypertension, and to evaluate the effect of plasma endotoxin on the prognosis of patients. Methods 57 patients with portal hypertension of our department received from Mar 2010 to Jan 2012 were included in this study. Testing the level of plasma endotoxin before the operation and 3 days, 1 week, 2 weeks after the operation. Child-Pugh classification,routine blood, liver and kidney function, the clotting series were determined before the operation. Counting the operation time, postoperative hospitalization days and complications. Results The plasma endotoxin level of patients with portal hypertension [ （ 27. 22 ± 5.42 ） pg/ml ] was much higher than that of healthy people [ （ 1.31 ± 0. 21 ） pg/ml ] ; the plasma endotoxin level was positively correlated with Child-Pugh score （ r = 0. 261, P 〈 0. 05 ） and total bile acid level （ r = 0. 129, P 〈 0. 05 ）, but it was negatively correlated with albumin level （ r = - 0. 265 ,P 〈 0. 05 ） ; besides, the endotoxin level of patients with ascites [ （ 57.42 ± 19.75 ） pg/ml ] was significantly higher than that without ascites[ （ 16.45 ± 1.71 ） pg/ml] ;the average level of the endotoxin（before the operation,3, 7,14 days after the operation）was positively related to the operation time and postoperative hospitalization days;there was a significant difference in endotoxin levels between patients with and without complications （ P 〈 0. 05 ）, and the endotoxin level is much higher in patients with infection than that with other complications. Conclusions Patients with portal hypertension suffer from endotoxemia, and it was aggravated along with the increasement of the liver cirrhosis severity. In addition, endotoxemia related to postoperative complications and it can be used to evaluate the short-term prognosis in patients.

关 键 词：肝硬化 高血压 门静脉 内毒素血症 围手术期 

分 类 号：R657.3[医药卫生—外科学]