中国药业
中國藥業
중국약업
CHINA PHARMACEUTICALS
2015年
12期
46-47,48
,共3页
肝门阻断%维拉帕米%乌司他丁%缺血-再灌注损伤%肝功能
肝門阻斷%維拉帕米%烏司他丁%缺血-再灌註損傷%肝功能
간문조단%유랍파미%오사타정%결혈-재관주손상%간공능
hepatic portal blocking%verapamil%ulinastatin%ischemia reperfusion injury%liver function
目的：探讨维拉帕米联合乌司他丁在肝脏叶段切除术前预处理对术后肝脏功能的保护作用。方法将肝胆外科2012年1月至2014年10月收治的行肝叶段切除的占位病变患者82例随机分为观察组42例和对照组40例。手术采用Pringle间歇肝门阻断法，对照组肝门阻断前经胃网膜右静脉推注乌司他丁注射液，观察组在对照组基础上联合使用维拉帕米注射液。肝门阻断前与血液复灌1h后切取少许健康肝组织测定三磷酸腺苷（ATP）与游离钙离子（Ca2+）浓度，术后每日监测肝转氨酶水平。结果两组患者术后早期转氨酶均较术前明显升高，而后呈逐步下降趋势；观察组患者术后1，3，5 d的丙氨酸氨基转移酶（ALT）、天门冬氨酸氨基转移酶（AST）水平均明显低于对照组（ P<0.05）；血流复灌后，观察组ATP水平略有下降，对照组明显下降，组间比较，差异有统计学意义（ P<0.05）；两组患者游离Ca2+浓度均明显上升，观察组明显低于对照组（ P<0.05）。结论乌司他丁与维拉帕米在肝脏叶段切除术肝门阻断前预处理，二者作用协同，较单用乌司他丁能维持相对稳定的肝内能量代谢，进一步降低术后肝功能损害。
目的：探討維拉帕米聯閤烏司他丁在肝髒葉段切除術前預處理對術後肝髒功能的保護作用。方法將肝膽外科2012年1月至2014年10月收治的行肝葉段切除的佔位病變患者82例隨機分為觀察組42例和對照組40例。手術採用Pringle間歇肝門阻斷法，對照組肝門阻斷前經胃網膜右靜脈推註烏司他丁註射液，觀察組在對照組基礎上聯閤使用維拉帕米註射液。肝門阻斷前與血液複灌1h後切取少許健康肝組織測定三燐痠腺苷（ATP）與遊離鈣離子（Ca2+）濃度，術後每日鑑測肝轉氨酶水平。結果兩組患者術後早期轉氨酶均較術前明顯升高，而後呈逐步下降趨勢；觀察組患者術後1，3，5 d的丙氨痠氨基轉移酶（ALT）、天門鼕氨痠氨基轉移酶（AST）水平均明顯低于對照組（ P<0.05）；血流複灌後，觀察組ATP水平略有下降，對照組明顯下降，組間比較，差異有統計學意義（ P<0.05）；兩組患者遊離Ca2+濃度均明顯上升，觀察組明顯低于對照組（ P<0.05）。結論烏司他丁與維拉帕米在肝髒葉段切除術肝門阻斷前預處理，二者作用協同，較單用烏司他丁能維持相對穩定的肝內能量代謝，進一步降低術後肝功能損害。
목적：탐토유랍파미연합오사타정재간장협단절제술전예처리대술후간장공능적보호작용。방법장간담외과2012년1월지2014년10월수치적행간협단절제적점위병변환자82례수궤분위관찰조42례화대조조40례。수술채용Pringle간헐간문조단법，대조조간문조단전경위망막우정맥추주오사타정주사액，관찰조재대조조기출상연합사용유랍파미주사액。간문조단전여혈액복관1h후절취소허건강간조직측정삼린산선감（ATP）여유리개리자（Ca2+）농도，술후매일감측간전안매수평。결과량조환자술후조기전안매균교술전명현승고，이후정축보하강추세；관찰조환자술후1，3，5 d적병안산안기전이매（ALT）、천문동안산안기전이매（AST）수평균명현저우대조조（ P<0.05）；혈류복관후，관찰조ATP수평략유하강，대조조명현하강，조간비교，차이유통계학의의（ P<0.05）；량조환자유리Ca2+농도균명현상승，관찰조명현저우대조조（ P<0.05）。결론오사타정여유랍파미재간장협단절제술간문조단전예처리，이자작용협동，교단용오사타정능유지상대은정적간내능량대사，진일보강저술후간공능손해。
Objective To investigate the protective effects of verapamil combined with ulinastatin pretreatment on postoperative liver function in liver lobe resection. Methods 82 cases of liver space-occupying lesion undergoing liver lobe resection in the hepatobiliary surgical department from January 2012 to October 2014 were randomly divided into the observation group(42 cases) and the control group(40 cases). The operation adopted the Pringle intermittent hepatic portal blocking method. The control group was injected with uli-nastatin through the right gastroepiploic vein before hepatic portal blocking,while on this basis the observation group was combined the use of verapamil injection. A little healthy liver tissue was taken before the hepative portal blocking and at 1 h after blood reperfusion, and the ATP and free calcium ion (Ca2+) concentration of liver tissue were determined. The postoperative hepatic transaminase levels were daily monitored. Results The early postoperative transaminase levels in the two groups were significantly increased compared with those before operation,then declined gradually;the ALT,AST values on postoperative 1,3,5 d in the observation group were significantly lower than those in the control group,the differences were statistically significant( P < 0. 05);after blood reperfusion,the ATP level in the observation group was slightly decreased,while that in the control group was decreased significantly,the difference between the two groups was statistically significant( P < 0. 05);the free Ca2 + concentration in the two groups was significantly increased,but the ob-servation group was significantly lower than the control group( P < 0. 05). Conclusion The pretreatment of ulinastatin and verapamil before hepatic portal blocking in live lobe resection has the synergistic effect,which can maintain a relative stability of liver energy metabolism and further reduces the postoperative liver damage than single use of ulinastatin.
