CAJ | 학술논문

目的探讨肝癌合并肝硬化患者术后应用人血白蛋白制剂的方法.方法回顾性分析2011年1月至2012年12月171例肝癌合并肝硬化患者肝切除术术后应用不同人血白蛋白治疗方案的临床资料.观察组88例术后48 h内给予5％人血白蛋白,以后给予20％人血白蛋白,直至检测血浆白蛋白达到正常水平.对照组83例术后给予20％人血白蛋白,直至检测血浆白蛋白水平达到正常值.比较两组患者术后临床指标、生化指标、并发症发生率、平均人血白蛋白用量以及术后平均住院时间.结果观察组术后48 h内组织间液量、腹腔引流量、术后平均人血白蛋白用量、血浆用量以及术后平均住院日数均明显低于对照组.观察组术后48 h内平均每日尿量、中心静脉压、平均动脉压明显高于对照组.在肝功能恢复方面,观察组与对照组在术后48 h内没有明显差异,但在48 h以后,观察组的肝功能明显好于对照组.结论肝癌合并肝硬化患者术后合理分配等渗性和高渗性白蛋白制剂,能够有效稳定患者血液循环、保障脏器有效灌注、促进肝功能恢复;与术后单独应用高渗性白蛋白制剂相比,可以减少总体白蛋白和血浆用量、缩短住院时间,达到更好的治疗效果.
목적 탐토간암합병간경화환자술후응용인혈백단백제제적방법.방법 회고성분석2011년1월지2012년12월171례간암합병간경화환자간절제술술후응용불동인혈백단백치료방안적림상자료.관찰조88례술후48 h내급여5％인혈백단백,이후급여20％인혈백단백,직지검측혈장백단백체도정상수평.대조조83례술후급여20％인혈백단백,직지검측혈장백단백수평체도정상치.비교량조환자술후림상지표、생화지표、병발증발생솔、평균인혈백단백용량이급술후평균주원시간.결과 관찰조술후48 h내조직간액량、복강인류량、술후평균인혈백단백용량、혈장용량이급술후평균주원일수균명현저우대조조.관찰조술후48 h내평균매일뇨량、중심정맥압、평균동맥압명현고우대조조.재간공능회복방면,관찰조여대조조재술후48 h내몰유명현차이,단재48 h이후,관찰조적간공능명현호우대조조.결론 간암합병간경화환자술후합리분배등삼성화고삼성백단백제제,능구유효은정환자혈액순배、보장장기유효관주、촉진간공능회복;여술후단독응용고삼성백단백제제상비,가이감소총체백단백화혈장용량、축단주원시간,체도경호적치료효과.
Objective To determine the role of human serum albumin therapy in the post-operative management of patients with hepatocellular carcinoma (HCC) associated with cirrhosis.Methods Between January 2011 and December 2012,we treated 171 consecutive cirrhotic patients with HCC.88 patients were treated with 5％ human serum albumin for 48 hours followed by 20％ human serum albumin in the post-operative period (the observer group) ; 81 patients were only treated with 20％ human serum albumin during the same time duration (the control group).The prognosis,complications,average amount of human serum albumin and plasma used as well as the in-hospital stay were observed.Results There were no deaths or major complications in either of these 2 groups.After treatment,the observer group was lower than the control group in the amount of intravenous fluid infused,the volume of peritoneal drainage,the amount of human serum albumin and plasma used as well as the mean post-operative hospitalization days (P ＜ 0.05).At the same time,the daily urine output,the central venous pressure and the mean arterial pressure within 48 hours after surgery were higher in the observer group than the control group.Furthermore the observer group had a smoother post-operative recovery in liver function,and the difference was significant between the two groups (P ＜ 0.05).Conclusion Not only did treatment with 5 ％ and 20％ human serum albumin gave the advantages of a more stable blood circulation,better organ perfusion and improved liver function recovery but it also reduced the amount of consumption of human serum albumin and plasma and shortened the hospital stay.